摘要
20世纪90年代中后期美国最大的公立医疗体系——退伍军人医疗服务系统进行了全面的改革,并在临床服务、患者满意度、运行效率和费用控制等方面迅速达到行业领先水平。通过对文献的综述和分析,本文认为美国退伍军人医疗服务系统改革的成功有两方面原因:宏观方面,组织结构的区域性整合与按人头支付的方式相结合,产生了加强预防保健和提升医疗质量的激励机制;微观方面,以绩效监测为手段改革管理机制,应用了适应临床需求的信息技术系统,服务重点从专科住院治疗快速转为初级保健。文章还讨论了其对我国公立医院改革的启示:公立医院改革的核心是建立责权统一的管理结构,而非产权变革;进一步整合的组织结构与按人头支付的方式相结合,可能创造出维护健康的激励机制;在把握宏观改革方向的基础上,科学的绩效管理方法、信息化技术和初级保健能够为医院发展和医疗卫生服务体系的快速转型发挥巨大的推动作用。
In the late 1990s, the largest and public health system of US, the Veterans Health Care System （VA） underwent a comprehensive reform. In half a decade, VA assumed industrial leadership in terms of health care quality, satisfaction, operational efficiency and cost containment. Through analysis of available literature, the study concluded that the success of VA reform lies in 2 aspects. In the macro aspect, regional integration of organizational structure was adopted along with a risk-adjusted per capita payment mechanism. The result is a closed health maintenance organization with strong incentive to invest in preventive health care and quality improvement. In the micro aspect, a performance-based management and a user-friendly information technology infrastructure were established with a quick shift from specialty-focus to emphasis on primary care. The article also discussed the implications of VA reform for public hospital reform in China： instead of privatization, organizational reform that matches accountability with power is the core of public hospital reform; further integration of organizational structure combined with capitation-based payment may generate solid incentive for health maintainance ; on the basis of macro level reform, scientific performance management, information technology and primary care can add great momentum to the development of hospitals and transformation of health delivery system.
出处
《中国卫生政策研究》
2012年第10期48-53,共6页
Chinese Journal of Health Policy
关键词
公立医院改革
美国退伍军人医疗服务系统
组织结构
管理
医疗质量
Public hospital reform
US Veterans Health Care System
Organizational structure
Management
Quality of health care
