我国医保支付方式本土化改革历程与价值导向完善建议

韦玮; 郑秉文

doi:10.19546/j.issn.1674-3830.2023.12.002

中国医疗保险 ›› 2023, Vol. 0 ›› Issue (12) : 13-20. DOI: 10.19546/j.issn.1674-3830.2023.12.002

专题分析

我国医保支付方式本土化改革历程与价值导向完善建议

韦玮, 郑秉文

作者信息 +

The Localization Reform Process of Medical Insurance Payment Method in China and Value-based Suggestions of Improvement

Author information +

文章历史 +

摘要

我国自1998年建立社会医疗保险制度以来,为应对医疗费用快速上涨、维护医保基金可持续运行,在吸收国外经验的基础上,从国家到地方进行了多种形式的医保支付方式本土化改革实践,取得了明显成效。本文在简单回顾“二战”以来国际医保支付方式改革进程的基础上,对我国医保支付方式改革本土化历程及与国际互动进行分析,总结我国医保支付方式改革的效果,并就增加我国医保支付方式价值导向提出建议。

Abstract

Since the establishment of the social medical insurance system in 1998, China has carried out various forms of localized medical insurance payment method reform from the state to the local level on the basis of absorbing foreign experience to cope with the rapid increase of medical expenses and maintain the sustainable operation of the medical insurance fund, which has achieved remarkable accomplishment. Based on a brief review of the process of international medical insurance payment reform since World War II, this paper analyzes the localization process of China's medical insurance payment reform and its interaction with the international payment reform, summarizes the effect of China's medical insurance payment reform, and provides suggestions on increasing the value orientation of China's medical insurance payment methods.

导出引用

韦玮, 郑秉文. 我国医保支付方式本土化改革历程与价值导向完善建议[J]. 中国医疗保险. 2023, 0(12): 13-20 https://doi.org/10.19546/j.issn.1674-3830.2023.12.002

The Localization Reform Process of Medical Insurance Payment Method in China and Value-based Suggestions of Improvement[J]. China Health Insurance. 2023, 0(12): 13-20 https://doi.org/10.19546/j.issn.1674-3830.2023.12.002

中图分类号： F840.684C913.7

参考文献

[1] World Health Organization.The World Health Report2010[EB/OL].(2012-06-16)[2023-12-05].https://www.who.int/publications/i/item/9789241564021.
[2] 郑秉文.“十四五”时期医疗保障可持续性改革的三项任务[J].社会保障研究,2021(02):3-14.
[3] National Bureau of Economic Research.Health care expenditures in the OECD[EB/OL].(2006-03-01)[2023-12-05].https://www.nber.org/bah/winter06/health-care-expenditures-oecd.
[4] 朱恒鹏,彭晓博.医疗价格形成机制和医疗保险支付方式的历史演变——国际比较及对中国的启示[J].国际经济评论,2018(01):24-38+4.
[5] 甘银艳,王海银,金春林.欧洲按服务单元付费应用进展及启示[J].中国卫生经济,2019,38(07):93-96.
[6] GAVENS M R.DRGs and PPS — their effect on hospitals[J].Society of nuclear medicine, 1989(17):16-22.
[7] HAFSTEINSDOTTIR E J G, SICILIANI L.DRG prospective payment systems:refine or not refine?[J].Health economics, 2010,19(10):1226-1239.
[8] 雷璐倩,张伶俐,颜建周,等.德国医疗保险支付方式改革及对我国的启示[J].中国卫生资源,2020,23(2):176-181.
[9] 刘子琼,单苗苗.医疗保险支付方式:国际经验与启示[J].卫生软科学,2019,33(8):68.
[10] 王亚琦,袁式屏.澳大利亚按病种付费制度对我国的启示[J].中国卫生经济,2019,38(4):94-96.
[11] BREDENKAMP C, BALES S, KAHUR K.Transition to diagnosis-related group payments for health[J].World bank publications, 2020.
[12] GERDTHAM U G, L THGREN M, TAMBOUR M, et al.Internal markets and health care efficiency:a multiple-output stochastic frontier analysis[J].Health economics, 1999, 8(2):151-164.
[13] ELLIS A P.Setting prices for disease:lessons from foreign experience[C].Paris, 2001.
[14] 安磊,么莉,冯晶晶,等.美国医保支付制度改革对我国康复护理服务的启示[J].中国卫生质量管理,2022,29(4):9-12.
[15] 孙辉,王海银,谢春艳,等.美国以价值为导向的医保支付模式应用及启示[J].卫生经济研究,2020,37(6):24-27.
[16] LINDSAYLINDSAY E.JUBELT, KEITH S.GOLDFELD, SAUL B.BLECKER, et al.Early Lessons on bundled payment at an academic medical center[J].Journal of the American academy of orthopaedic surgeons, 2017(25):654-663.
[17] Centers for Medicare and Medicaid Services.Affordable care act’s shared savings program continues to improve quality of care while saving Medicare money during the COVID-19 pandemic[EB/OL].(2021-08-25)[2023-12-05].https://www.cms.gov/newsroom/press-releases/affordable-care-acts-shared-savings-program-continues-improve-quality-care-while-saving-medicare.
[18] Nuffield Trust.The NHS payment system:evolving policy and emerging evidence[EB/OL].(2014-02-20)[2023-12-05].https://www.nuffieldtrust.org.uk/research/the-nhs-payment-system-evolving-policy-and-emerging-evidence.
[19] Centers for Medicare and Medicaid Services.White paper-synthesis of evaluation results across 21 Medicare models[EB/OL].(2022-07-19)[2023-12-05].https://www.cms.gov/priorities/innovation/data-and-reports/2022/wp-eval-synthesis-21models.
[20] 中国医疗保险.一文读懂DRG在我国的历史变迁[EB/OL].(2023-05-06)[2023-12-05].https://mp.weixin.qq.com/s/RpY8G4Uaj5zy7lW9ABt54A.
[21] 国家医疗保障局.关于印发疾病诊断相关分组(DRG)付费国家试点技术规范和分组方案的通知[EB/OL].(2019-10-24)[2023-12-05].http://www.nhsa.gov.cn/art/2019/10/24/art_37_1878.html.
[22] 国家医疗保障局.2019年全国医疗保障事业发展统计公报[EB/OL].(2020-06-24)[2023-12-05].http://www.nhsa.gov.cn/art/2020/6/24/art_7_3268.html.
[23] 廖藏宜.中国医保DRG付费改革探索的三个阶段[J].中国人力资源社会保障,2020(01):60.
[24] 邹伏英,熊瑶,邹俐爱,等.按病种收(付)费相关规范研究探讨[J].中国卫生事业管理,2017,34(08):589-592.
[25] 应亚珍,曹庄.如何认识DIP改革的后发优势[J].中国卫生,2020(12):47-48.
[26] 国家医疗保障局.国家医疗保障局办公室关于印发国家医疗保障按病种分值付费(DIP)技术规范和DIP病种目录库(1.0版)的通知[EB/OL].(2020-11-20)[2023-12-05].http://www.nhsa.gov.cn/art/2020/11/20/art_53_3988.html.
[27] 倪沪平.肝移植术“价值医保支付”探索[J].中国社会保障,2020(12):84.
[28] 廖藏宜,秦纪华,蓝志成.中医优势病种按疗效价值付费的柳州经验[J].卫生经济研究,2023,40(06):61-63+67.
[29] 胡琳琳,龙飞,李佳,等.康复病组按价值付费的“长沙模式”[J].中国医疗保险,2022(06):74-79.
[30] 国家医疗保障局.关于印发DRG/DIP支付方式改革三年行动计划的通知[EB/OL].(2021-11-26)[2023-12-05].http://www.nhsa.gov.cn/art/2021/11/26/art_104_7413.html.
[31] 国家医疗保障局.2018年全国基本医疗保障事业发展统计公报[EB/OL].(2019-06-30)[2023-12-05].http://www.nhsa.gov.cn/art/2019/6/30/art_7_1477.html.
[32] 国家医疗保障局.2022年全国医疗保障事业发展统计公报[EB/OL].(2023-07-10)[2023-12-05].http://www.nhsa.gov.cn/art/2023/7/10/art_7_10995.html.
[33] 黄华波.医保支付方式改革取得积极进展[EB/OL].(2022-11-14)[2023-12-05].https://mp.weixin.qq.com/s/cnxfEDOyoOgLcBnFP7txzg.
[34] 金春林,王海银,孙辉,等.价值医疗的概念、实践及其实现路径[J].卫生经济研究,2019,36(02):6-8.