RBRVS的兴起与发展对我国社会医疗保险支付的政策启示

RBRVS具有控制医疗卫生费用过快上涨、以富有激励性的医师费支付消除医务人员行为扭曲的作用,其核心功能与我国当前医改面临的问题十分契合。本文从宏观政策视角对RBRVS展开研究,回顾了RBRVS的兴起背景、发展历程、应用优势及其支撑条件。在对我国学术研究和实践探索展开系统性分析的基础上,明晰当前RBRVS在应用中面临未引起卫生政策制订者的足够重视、对RBRVS的激励相容导向关注不足、运行RBRVS的支撑体系薄弱、缺少基于宏观考量的医务人员薪酬支付体系规划等主要问题,据此提出借鉴RBRVS关于医疗保险支付制度的设计精髄、运用医保支付激励达成卫生政策目标、逐步引入按质量付费导向的支付方式、规划契合我国诊疗服务模式的医师费支付方式以及系统评估将其引入社会医疗保险支付的可行性等对策与建议,旨在为推进我国社会医疗保险支付改革提供参考。

The design and development of RBRVS and its implications for China's social health insurance payment methods

Resource-based Relative Value Scale (RBRVS) serves to the aims of cost control in health care, and guiding the behavior of healthcare providers by altering the payment incentive structure. The core function of the RBRVS may address the major challenges in the health care reform in China at present. From the perspective of policy research, this article reviews the origin, arising and development of RBRVS, as well as its advantages in application, and its supporting conditions. The systematic review on domestic studies on this topic, clarifies the main issues existing today:inadequate emphasis among policy-makers on RBRVS, less concern to the incentive compatibility mechanism of RBRVS,weak supporting conditions for RBRVS, lack of a payment system for physicians basing on macro-planning. Therefore, recommendations are put forward to suggest policy-making on advancing the health insurance payment reform in China, including 1)Apply the core of the RBRVS design, which is the usage of payment incentives; 2)Achieve the health policy goal using the incentive mechanism of medical insurance payment; 3)Gradually introduce the method of pay for quality;4)Design the payment mode of physician fee based on our health service practice; 5)Systematically evaluate the plausibility of introducing RBRVS into our medical insurance payment.