我国医保支付方式改革的有效性边界研究

从理论角度阐述我国医保支付方式改革对医疗服务结果影响的作用机制,并分析医保支付方式在医改中的功能定位及该项改革工作在实现预期效果方面的有效前提。结果表明,支付方式改革可视作公立医院改革的重要抓手,但不是改革的核心。我国医保支付方式改革要实现预期目标,需要同时满足内外部多个传导前提:(1)区域内公共医疗保障程度需达到一定水平;(2)医疗服务供方的筹资体系相对处于封闭状态;(3)需要辅以取消药品加成政策;(4)需要与医院分配制度改革相衔接。按病种支付可以缓解当前医疗费用过快增长的压力,但无法从根本上避免公立医院的逐利倾向。同时改革过程中警惕异地就医可能带来的跨域性医保财政逆向转移的陷阱。

Effectiveness frontier analysis of the medical payment reform in China

In this paper, we theoretically analyzed how hospital payment reform affect the health service results and the function of payment reform in China''s health care system. Furthermore, we concluded the preconditions of how the payment reform achieved its intended goals. Our results suggest, payment reform could be regarded as the point cut but not the core for public hospital reform. Four prerequisites should be met before the payment reform policy achieve the prospective aims:(i) the public health insurance degree have reached to some extent in the region; (ii) the hospital financing system is assumed to be relatively sealed; (iii) should be supplemented with drug mark-up policy reform; (iv) should be combined with hospital salary distribution mechanism reform. The case payment reform could alleviate the pressure of current rising health costs, but it could not avoid the provider''s profit-driving behavior. Additionally, policymakers should pay attention to the "trap" of cross-regional insurance fiscal transfer after the instant settlement system for extraterritorial medical treatment is online.