医疗服务竞争机制优化和“纵向整合”的医疗服务体系.pdfVIP

医疗服务竞争机制优化与“纵向整合”的医疗服务体系 匡莉1一 1. 中山大学公共卫生学院 广州市中山二路74 号，510080 【摘要】新医改时期，我国医疗服务引入市场机制已成必然选择,但如何完善当前的竞 争机制亟待研究的深入推进。本研究首先给出了衡量一个有效的竞争机制的标准；辨析了我 国目前的竞争机制是医疗服务机构与机构间在 “个体水平”上相互竞争、以机构完成医疗服 务量作为激励机制，并结合医疗服务特征，阐述了这是一种低效的竞争机制。提出“系统水 平”上的竞争是今后我国新医改医疗服务竞争机制的选择，即在区域内构建多个“纵向整合” 的医疗服务体系，竞争在系统与系统之间进行、以服务人群的健康改善作为激励机制。最后， 对全球医疗服务竞争机制的演变进行了回顾，从经验上验证了上述理论分析的结论。 【关键词】医疗服务，竞争机制，医疗服务提供体系，纵向整合 Optimizing the mechanism of Health care competition for New Health Reform in China and Vertical Integrated Health Care Delivery Systems KUANG Li 【Abstract 】 It is an essential choice to introduce market mechanism into health care delivery system for the New Health Reform in China and improving the current competition mechanism urgently calls for further research. This paper firstly set up standards of evaluating whether the competition mechanism is effective and then to clarify the current competition mechanism as “organizational-level” competition together with a fee-for-service incentives. Based on the standards and the characteristics of health care service, the paper conducts a deep-analysis with a conclusion that the organizational-level competition mechanism is inefficient. Secondly, the paper fourthly expounds the advantages hold by IDSs （vertically integrated delivery systems ） and propose that the system level competition mechanism maybe is future choice for New Health Reform of China, namely establishing several IDSs in a region, the systems compete with each other and use the health improvement of population as incentive. Finally, the paper makes a review of evolution of global health care competition mechanism and empirically proves the conclusion of what has been discussed above. 【Key words 】 health care service ，competition mechanism, delivery system, vertical integration 1.问题的提出 关于我国医疗改革方向和思路的争论主要有“政府派”和“市场派”，随着讨论的深入， 一基金项目：2009年广东省卫生厅科技项目《广东省医疗卫生服务体系发展规划及相关