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荷兰试图通过医保捆绑支付改革来推动卫生服务整合。文章总结梳理了捆绑支付的制度设计,发现捆绑支付促进了卫生服务提供者之间的协调与合作,但也带来医疗费用增加、医保重复支付和管理成本增加等问题。剖析了我国支付方式对卫生服务整合导向性作用缺位的现状,提出支付方式改革对推动卫生服务提供体系改革的作用,倡导通过支付方式改革营造竞争环境,指出直接作用于医生的支付方式的重要性,并提出变捆绑支付为基于风险调整的按人头支付的制度优化建议。
The Netherlands is trying to promote the integration of health services through health care bundling reform. The paper summarizes the system design of bundled payment and finds that bundle payment promotes coordination and cooperation among health service providers, but also brings about such problems as the increase of medical expenses, the duplication of medical insurance and the increase of management costs. Analyzes the status quo of the lack of directing effect of payment on health service in our country, proposes the role of payment reform in promoting the reform of health service delivery system, advocates the reform of payment system to create a competitive environment, points out the importance of direct payment to doctors And put forward the idea of changing bundled payment system based on risk-adjusted pay-as-you-go system.