医院管理与融资

HealthResearch1医院管理与融资HealthResearch2OrganisationandfinancingofhospitalservicesinNorway挪威医院服务的管理和融资InNorway,thefinancingandprovisionofhospitalservicesismainlyapublicresponsibility,financedbyincomeandwealthtaxation.Butonecanalsofindasignificantprivatecontributionintermsofbothfinancingandprovision,whichhasbecomemoreimportantinrecentyears.在挪威，医院服务的筹资和供应基本上是一项公共职责，由所得税和福利税负担。但是筹资和供给中的私有资产也拥有重要份额，近年来还不断增加。ThepoliticalresponsibilityandcontrolofhospitalserviceslieswiththeMinistryofHealthandCareServices,i.e.thenationalhealthauthorityisresponsibleforthefinancing,planningandprioritizingofhealthservicesatthenationallevel.卫生与社会事务部在政治上负责并管理医院服务，即作为全国的权威负责筹资、指定规划，并且在国家层面上保证卫生服务的优先性。HealthResearch3Organisationofhospitalservices医院服务的管理TheresponsibilityofprovidinghospitalservicesisdelegatedtofiveRegionalHealthAuthorities(RHA),whichareorganizedascentralgovernmentally-ownedenterprises.TheRHAexercisesstateownershipandhastheresponsibilityforprovidingservicestothepopulationinthehealthregion,withintheframeworkstatedbytheoverallhealthpoliticalgoals.医院服务的供应职责交由五个地区的卫生机构(RHA)，按照中央政府所有的企业进行管理RHA实行国有制，在卫生事业的政治目标规定的框架中负责为该地区人口提供卫生服务Theresponsibilitiesalsocoverspecializedmental-healthservicesandhospitalservicestopersonswithdrug-relatedhealthproblems.这些职责还包括特别的精神健康服务，以及为患有毒品相关健康问题的人群提供医院服务TheproductionofhospitalservicesisperformedmainlybylocalHealthAuthorities(HA)ownedbytheRHAsorwithprivate,non-profit,hospitalsthathaveaprovisionalagreementwiththeRHA.ThelocalHAconsistsofoneormorehospitals.TheRHAsupplementsitsownproductionwithpurchasesfromprivate,for-profit,providers.地区的卫机构(RHA)拥有的地方卫生局(HA)以及和RHA签订临时协议的私有非营利性医院医院服务主要生产具体的医院服务产品。地方卫生局(HA)拥有一个或更多的医院。地区卫生局在自己的产品之外，还从私有营利性供应者那里购买。HealthResearch4Financingofhospitalservices医院服务的融资ThemajorelementsinthefinancingoftheRHAare:地区性卫生机构的主要融资因素包括：Activity-basedfinancing;基于医院行为的资金In-patientandout-patienspaymentschemes.住院和门诊费用Blockgrants(needs-equalizationgrants)distributedamongtheRHAsaccordingtosocio-demographiccharacteristics(e.g.age-composition)ofthepopulation.根据社会-人口特点（如年龄结构）在地区的卫生机构中分配的整笔拨款（需求均分资助）Differentear-markedgrants.不同的特殊用途的资金Thereisalsoout-of-pocketpayment(userfees)forout-patienthospitalservices(butthesefinancelessthan2%oftotalcosts).还有患者自负的门诊费用（但是此部分少于总额的2%）Noout-of-pocketpaymentsforinpatienthospitalservices没有个人承担的住院费用RHAsarefreetochoosetheirownsystemofhospitalfinancing.MostRHAshavechosento”copy”thenationalmodelcombiningpopulation-basedgrantswithactivity-basedfinancing,i.e.givingthelocalhealthauthoritiesasortofpopulationresponsibility.地区卫生机构可以自由选择各自的医院融资体系。多数地区卫生机构选择“复制”国家模式，把基于人口的资金和基于医院行为的资金结合起来，即赋予地方卫生机构一定程度的人口责任。HealthResearch5TotalhealthcareexpenditureinNorwayPrimaryandsecondary(2004)2004年挪威初级和二级医疗卫生总支出26billionUSD260亿美元Primary18.5billion初级185亿美元secondary7.5billionUSD二级75亿美元5800USDperperson人均5800美元9.9%ofGDP占GDP的9.9%Publicexpenditurein%oftotalexpenditure:85.5(2003)公共支出占总支出的85.5%（2003年）Privateexpenditurein%oftotal:14.5私人支出占总支出的14.5%（2003年）Johnsenp.32HealthResearch6Expenditurebyfunction,Secondary20042004年二级支出（按不同功能分类）Inpatientanddaycasesofcurativecare28.6%住院及其每日药品诊疗Outpatientcurative17.7%门诊治疗Servicesofrehabilitativecare1.4%康复治疗服务Inpatientlongtermnursing15.2%长期住院护理Homesbasedlongtermnursingcare7.5%长期家中护理Clinicallaboratoryanddiagnosticsimaging3.3%临床实验和透视诊断Patienttransportandemergencyrescue2.3%病患转移和急救Medicalgoodsdispensedtopatients13.9%患者所用药品Preventionandhealthadministration2.8%疾病预防和行政Capitalformationofhealthcareproviderinstitutions7.2%卫生保健供应机构的资金份额Johnsenp.38HealthResearch7Privatesupplement私有的补充部分Inlateryears,theprivatesupplementofhospitalserviceshasbecomeincreasinglyimportant.近些年，私有的医院服务日趋重要Thenumberofprivate,for-profit,providershasgrown.私有营利性供应者数目增长Therangeandscaleofactivities(out-patientanddaysurgery)hasincreased.活动范围和规模增长（包括门诊和工作日的手术）Thepublicprovidersarethemajorpurchasers,butthereisalsoprivatelyfinancedpurchasesandaprivatehealth-insurancemarketisemerging.公共供应者仍旧是主要购买者，但是私人融资的购买者和私有健康保险市场正在涌现HealthResearch8Summary总结Twoseparatemanagementandfinancingsystemsinhealthcare在医疗上两种不同的管理和融资体制Primaryhealth:(Local)Municipalityplanning,implementationandfinancing(+NIS)初级卫生保健（地方）市政当局的规划、执行和融资（+NIS）Secondaryhealth:二级卫生(National)stateresponsibilityandfinancing（国家）国家职责和融资Healthenterprisesplanningandimplementing卫生企业规划和执行Primaryhealthcare:smallout-of-pocketpayment(12y)初级卫生:少量自负费用（大于12岁）Consultations,procedures,medicines咨询、治疗过程、用药Roof最高限度Secondaryhealthcare:totallyfreeforeveryone二级卫生：所有人全部免费Nonetheless:socialinequalitiesinhealth,refProf.Westin’slecture尽管如此，卫生领域还是存在社会不平等，参考Westin教授的讲座