医疗费用过快增长的动力机制和控制策略谫论

医疗费用增长的原因是多方面的、不可避免的。但从经济学分析，医疗服务具有垄断性、委托-代理双重性和需求刚性。在利益机制驱动下，医疗项目的选择变成供方偏好，是医疗费用快速攀升的症结之一。变按项目支付为按病种支付，是控制医疗费用快速上涨、深化卫生改革的重要措施之一。按病种支付的方法有多种，比较科学、合理的是按病种组合支付。

Discussion of the driving force and checking strategy for the unduly rapid increase of medical fees

The increase of medical fees, which can be attributed to many factors, is inevitable. However, from the perspective of economics, medical services are characterized by monopolization, the dual nature of entrust-ment and agency and the inflexibility of demands. Driven by the pursuit of profits, suppliers are keen on the kind of medical programs they provide, leading in part to the excessively rapid increase of medical fees. One of the key mea-sures for checking this increase and deepening health reform is to replace payment by programs with payment by case groups. Payment by case groups can be implemented in many ways. A relatively scientific and rational way is payment by case mix.