摘要
以实施药品零差率和调整医疗服务价格为核心的公立医院补偿机制改革,是对公立医院药品和医疗服务价格体系进行的重要结构调整,对医药总费用及其结构产生了重要影响,进而影响医疗保险基金支出和个人医疗费用负担。改革的目标"医保基金可承受、个人负担不增加",则遭到了医疗总费用上涨的挑战。论文通过对浙江省的省级公立医院补偿机制改革进行实证分析,发现改革后省级医院综合补偿率为134%,大大高于政策规定的90%;省级医保基金支出和参保者个人负担都显著增加,并没有达到医药费用"总量控制"的目标;在揭示了医疗费用上涨由价格和使用量共同作用的基础上,呼吁关注改革对各利益主体行为变化的影响及其造成服务量增加的事实。
Public hospital reimbursement system reform,based on drugs without added profits or an increase in healthcare service prices,was an important structural adjustment for the drug and healthcare services system. It impacts the medical costs,the medical insurance funds expenditures,and the disease burden shared by individuals. The reform encountered a challenge from the great growth in medical expenditures. And it was reasonable to question whether the health care reform could achieve the objective of sustainable medical insurance funds and decrease the individual burden. This article employed an empirical study in Zhejiang province and found the comprehensive reimbursement rate raised to 134 %,outclass 90 % of that according to policy target.Both medical insurance expenditures and the burden shared by individuals increased dramatically,and fail to fulfill the objective of controlling total expenses. According to a covariance of price and quantity of healthcare services,this study encourages paying much more attention to the changed quantity of services. This change could be caused by behavioral motivations for stakeholders in the process of healthcare reform. This is a risk for balancing medical insurance funds and increasing the individual burden of disease costs.
出处
《公共行政评论》
CSSCI
北大核心
2015年第5期30-49,186-187,共20页
Journal of Public Administration
基金
国家社科基金青年项目(14CSH056)、国家社科基金重大项目(13&ZD163)
关键词
省级公立医院
补偿机制
医保基金个人负担
Provincial Level Public Hospital
Reimbursement Mechanism
Medical Insurance Fund
Burden Shared by Individual
