医院管理与融资.pptx

Health Researchn医院管理与融资医院管理与融资1医院管理与融资第1页Health ResearchOrganisation and financing of hospital services in Norway 挪威医院服务管理和融资挪威医院服务管理和融资nIn Norway,the financing and provision of hospital services is mainly a public responsibility,financed by income and wealth taxation.But one can also find a significant private contribution in terms of both financing and provision,which has become more important in recent years.在挪威，医院服务筹资和供给基本上是一项公共职责，由所得税和福利税负担。不过筹资和供给中私有资产也拥有主要份额，近年来还不停增加。nThe political responsibility and control of hospital services lies with the Ministry of Health and Care Services,i.e.the national health authority is responsible for the financing,planning and prioritizing of health services at the national level.卫生与社会事务部在政治上负责并管理医院服务，即作为全国权威负责筹资、指定规划，而且在国家层面上确保卫生服务优先性。2医院管理与融资第2页Health ResearchOrganisation of hospital services 医院服务管理医院服务管理nThe responsibility of providing hospital services is delegated to five Regional Health Authorities(RHA),which are organized as central governmentally-owned enterprises.The RHA exercises state ownership and has the responsibility for providing services to the population in the health region,within the framework stated by the overall health political goals.医院服务供给职责交由五个地域卫生机构(RHA)，按照中央政府全部企业进行管理 RHA实施国有制，在卫生事业政治目标要求框架中负责为该地域人口提供卫生服务nThe responsibilities also cover specialized mental-health services and hospital services to persons with drug-related health problems.这些职责还包含尤其精神健康服务，以及为患有毒品相关健康问题人群提供医院服务nThe production of hospital services is performed mainly by local Health Authorities(HA)owned by the RHAs or with private,non-profit,hospitals that have a provisional agreement with the RHA.The local HA consists of one or more hospitals.The RHA supplements its own production with purchases from private,for-profit,providers.地域卫机构(RHA)拥有地方卫生局(HA)以及和RHA签署暂时协议私有非营利性医院医院服务主要生产详细医院服务产品。地方卫生局(HA)拥有一个或更多医院。地域卫生局在自己产品之外，还从私有营利性供给者那里购置。3医院管理与融资第3页Health ResearchFinancing of hospital services 医院服务融资医院服务融资nThe major elements in the financing of the RHA are:地域性卫生机构主要融资原因包含：nActivity-based financing;基于医院行为资金nIn-patient and out-patiens payment schemes.住院和门诊费用nBlock grants(needs-equalization grants)distributed among the RHAs according to socio-demographic characteristics(e.g.age-composition)of the population.依据社会-人口特点（如年纪结构）在地域卫生机构中分配整笔拨款（需求均分资助）nDifferent ear-marked grants.不一样特殊用途资金nThere is also out-of-pocket payment(user fees)for out-patient hospital services(but these finance less than 2%of total costs).还有患者自负门诊费用（不过此部分少于总额2%）nNo out-of-pocket payments for inpatient hospital services 没有个人负担住院费用nRHAs are free to choose their own system of hospital financing.Most RHAs have chosen to”copy”the national model combining population-based grants with activity-based financing,i.e.giving the local health authorities a sort of population responsibility.地域卫生机构能够自由选择各自医院融资体系。多数地域卫生机构选择“复制”国家模式，把基于人口资金和基于医院行为资金结合起来，即赋予地方卫生机构一定程度人口责任。4医院管理与融资第4页Health ResearchTotal health care expenditure in Norway Primary and secondary()年挪威初级和二级医疗卫生总支年挪威初级和二级医疗卫生总支出出n26 billion USD 260亿美元nPrimary 18.5 billion 初级185亿美元nsecondary 7.5 billion USD 二级75亿美元n5800 USD per person 人均5800美元n9.9%of GDP 占GDP9.9%nPublic expenditure in%of total expenditure:85.5()公共支出占总支出85.5%（年）nPrivate expenditure in%of total:14.5 私人支出占总支出14.5%（年）nJohnsen p.325医院管理与融资第5页Health ResearchExpenditure by function,Secondary 年年二级支出（按不一样功效分类）二级支出（按不一样功效分类）nInpatient and day cases of curative care 28.6%住院及其每日药品诊疗 nOutpatient curative 17.7%门诊治疗nServices of rehabilitative care 1.4%康复治疗服务nInpatient long term nursing 15.2%长久住院护理nHomes based long term nursing care 7.5%长久家中护理nClinical laboratory and diagnostics imaging 3.3%临床试验和透视诊疗nPatient transport and emergency rescue 2.3%病患转移和抢救nMedical goods dispensed to patients 13.9%患者所用药品nPrevention and health administration 2.8%疾病预防和行政nCapital formation of health care provider institutions 7.2%卫生保健供给机构资金份额nJohnsen p.386医院管理与融资第6页Health ResearchPrivate supplement 私有补充部分私有补充部分nIn later years,the private supplement of hospital services has become increasingly important.近些年，私有医院服务日趋主要nThe number of private,for-profit,providers has grown.私有营利性供给者数目增加nThe range and scale of activities(out-patient and day surgery)has increased.活动范围和规模增加（包含门诊和工作日手术）nThe public providers are the major purchasers,but there is also privately financed purchases and a private health-insurance market is emerging.公共供给者依旧是主要购置者，不过私人融资购置者和私有健康保险市场正在涌现7医院管理与融资第7页Health Research Summary 总结总结nTwo separate management and financing systems in health care 在医疗上两种不一样管理和融资体制nPrimary health:(Local)Municipality planning,implementation and financing(+NIS)初级卫生保健（地方）市政当局规划、执行和融资（+NIS）nSecondary health:二级卫生n(National)state responsibility and financing（国家）国家职责和融资nHealth enterprises planning and implementing 卫生企业规划和执行nPrimary health care:small out-of-pocket payment(12 y)初级卫生:少许自负费用（大于12岁）nConsultations,procedures,medicines 咨询、治疗过程、用药nRoof 最高程度nSecondary health care:totally free for everyone 二级卫生：全部些人全部无偿nNone the less:social inequalities in health,ref Prof.Westins lecture 尽管如此，卫生领域还是存在社会不平等，参考Westin教授讲座8医院管理与融资第8页