摘要
本文通过卫生筹资方式的分析，提出了进行卫生筹资与就医、处方行为研究的理论模型，研究指标与资料收集方法。并在介绍国内外研究结果以后提出了一些进行卫生筹资改革的建议。我们发现卫生筹资方式与支付机制对病人与医生的行为以及药物使用都有影响。相对于自费病人来说，保险病人有更多的机会得到新药与贵药、住院治疗与向高层次医院转诊，也消耗更多的卫生资源。以按服务收费为基础的保险可增加临床服务与药品消费，并导致卫生费用快速增长，医生可能根据病人的保险情况与支付能力改变处方与治疗方案，并且认为与服务和处方挂钩的奖金制度有可能刺激过多用药行为。建议有关决策部门在出台有关卫生筹资与支付方式政策时，要考虑医生与病人的行为变化对药物及其它服务使用的影响，并同时要有一套规范医生与病人行为的措施，减少资源浪费与使得新政策健康发展、建议有关部门进行合理用药研究，进一步达到降低卫生费用与提高质量的改革目的。
After analyzing health financing methods , a model was suggested for studytng the relationship between health financing and health care-seeking and prescribing behaviors as well as indicators and data collection methods . After intreducing som researchresults, suggestions were made for health financing reform in China. It seemed that health financing and paymenty mechanismsinflucnced patients' and doctors' behaviors and drug use. Compaed to uninsured patients, the insared had more chances to get neweror nlore expensive drugr, inoatient care and to be referred to a higher health facility and consume more health resources. Health insruce hased on fee-for-service could lead to a higher growth of health expenditure(especially curative care expewhtare) includingdrugs. Physicians might change their prescriptions according to patient's health financing and financial ability. They also thoughbonus related to services or prescriptions had an incentive to overuse of drugs. It is suggested that relevant decision makers shouldconsider patients' and doctors' behaviors in the use of health seriices in making or changing health financing and payment mechamisms . While puhlishing a new health financing method, decision makers should have some measures to control the behaviors of usinghealth care in order to lessen the waste of health resources and make the new method work smoothly. It was the suggeted that relevanthealth authorities should study the situation of rational use of drugs in onier to decrease health costs and improve health care quality.
出处
《中国卫生资源》
1998年第1期24-26,共3页
Chinese Health Resources
