CAJ | 학술논문

政府主导的医疗机构补偿机制一直未变，按项目支付方式的固有弊病决定了医疗机构通过“多开药、多做检查”的浪费行为获得补偿。社会各界所议论的问题众多，其中，补偿机制抑或支付方式不合理是首要的关键问题，其他问题均衍生于此。基于30余年医改研究基础，中心认为：只要补偿机制不变，医疗机构不可能形成主动节约资源行为，针对衍生问题的治标措施就缺乏前提。政府迫切需要把握关键，构建合理补偿机制，否则事倍功半。在此基础上，县级公立医疗机构改革、社会资本办医、基本药物制度及基层改革等才能顺利开展并实现应有价值。
정부주도적의료궤구보상궤제일직미변，안항목지부방식적고유폐병결정료의료궤구통과“다개약、다주검사”적낭비행위획득보상。사회각계소의론적문제음다，기중，보상궤제억혹지부방식불합리시수요적관건문제，기타문제균연생우차。기우30여년의개연구기출，중심인위：지요보상궤제불변，의료궤구불가능형성주동절약자원행위，침대연생문제적치표조시취결핍전제。정부박절수요파악관건，구건합리보상궤제，부칙사배공반。재차기출상，현급공립의료궤구개혁、사회자본판의、기본약물제도급기층개혁등재능순리개전병실현응유개치。
The hospital reimbursement mechanism directed by the government remains unchanged. Due to the inherent drawback of fee-for-service payment,the hospitals had to rely on the wasteful behaviors,“more drug more profits” and“more examination more profits”. There are a lot of problems discussed by the sectors of the society. Among all the problems,the unreasonable reimbursement mechanism is the first key problem,and other problems derive from it. Based on the previous research for more than 30 years,the authors pointed out that as long as the reimbursement mechanism,or the payment system exists,the hospitals will not take the behaviors of saving health resources,and other measures toward the derived problems will lack essential premise. It is a prerequisite that the government needs to solute the key problem and build a reasonable reimbursement mechanism,otherwise,the health reform will not take effect. Based on the reform of the key problem,the reform of public hospitals at the county level,development of private medical institutions,the essential drug system,and the reform of the grass-roots level can carry out smoothly and achieve the expected effects.