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支付方式改革能够推动医联体、分级诊疗等机构间的服务协作关系的建立,DRGs与按人头付费能够带来服务质量的提升与成本降低。不同的支付方式对机构间的协作效应不同,医保的统筹层次与其带来的服务组织整合的程度一一对应,按项目付费只能够影响个体医生的行为,而按人头预付整合的服务供给体系更容易形成,随着医保服务统筹的层次越高,在其作用下能够实现的组织整合程度也就越高,同时不同统筹层次下的评估重点也有所差异。所以,应针对不同的改革需求,选择相应的支付方式,同时也要考虑医保的支付效率与改革的难易程度。
The reform of payment methods can promote the establishment of service collaboration between medical institutions, grading clinics and other agencies. DRGs and pay-per-user can bring about improvements in service quality and cost reduction. Different payment methods have different effects on the cooperation among agencies. The overall level of medical insurance corresponds with the degree of integration of service organizations. Paying by project can only affect the behavior of individual physicians, and moreover, the pre-paid integrated service provision system It is easy to form. As the level of medical insurance service co-ordination is higher, the degree of organizational consolidation that can be achieved under its influence is higher, and the evaluation priorities under different levels of co-ordination are also different. Therefore, we should choose the appropriate payment method according to the different needs of the reform, and at the same time, we should also consider the payment efficiency of medical insurance and the ease of reform.