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英美两国按价值付费实践和绩效评价指标发展对我国的启示

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在寻求人人享有高质量可负担的医疗服务共同目标下,控制医疗成本、关注医疗服务效果与健康效果已成为全球医疗卫生改革的重要命题.按价值付费通过在控费的同时,关注健康产出,规范医疗行为,引领医疗服务体系的价值导向,而如何将医疗服务行为、价值评价指标与医保支付相结合是推行按价值付费的关键问题.文章通过梳理英美两国按价值付费的实践和绩效评价指标体系的发展,比较分析4种以价值为导向的医保项目在评价对象、支付方式、指标维度以及奖惩措施等方面的异同点,探讨按价值付费面临的挑战,提出在我国医保支付方式改革实践中,应强调关注绩效评估与质量指标、将医防融合理念融入绩效评价指标维度、从患者参与维度提高医疗服务效果等方式融入价值付费的理念,为推进按价值付费在我国的本土化提供借鉴.
The Value-Based Payment and the Development of Performance Evaluation Indicators in the UK. and the US. and Implications for China
Under the common goal of seeking high-quality and affordable medical services for everyone,controlling medical costs and paying attention to the effects of medical services and health have become important propositions of global medical and health reform. Value-based payment leads the value orientation of the healthcare delivery system by focusing on health output while controlling costs and regulating medical behavior. However,how to combine medical service behavior,value evaluation index and medical insurance payment are the key issues to implement value-based payment. By reviewing the practice of value-based payment and the development of performance evaluation index system in the UK. and the US.,it compares and analyzes the similarities and differences of four value-based medical insurance projects in terms of evaluation objects,payment methods,index dimensions and reward and punishment measures,discusses the challenges faced by value-based payment,and proposes that in the practice of payment reform in China,emphasizing paying attention to performance evaluation and quality indicators,integrating the concept of medical and preventive integration into the dimension of performance evaluation indicators,and improving the effect of medical services from the dimension of patient participation,so as to provide references for promoting the localization of payment by value in China.

value-based healthcarevalue-based paymentmedical insurance payment methodperformance evaluation

侯新宇、赵宁、顾梅、赵婧萱、杨佳

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首都医科大学公共卫生学院 北京 100069

价值医疗 按价值付费 医保支付方式 绩效评价

2024

中国卫生经济
中国卫生经济学会,卫生部卫生经济研究所

中国卫生经济

CSTPCDCHSSCD北大核心
影响因子:1.524
ISSN:1003-0743
年,卷(期):2024.43(12)