醫(yī)院管理與融資

1、1Organisation and financing of hospital services in Norway 挪威醫(yī)院服務(wù)的管理和融資In 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 provis

2、ion, which has become more important in recent years. 在挪威，醫(yī)院服務(wù)的籌資和供應(yīng)基本上是一項(xiàng)公共職責(zé)，由所得稅和福利稅負(fù)擔(dān)。但是籌資和供給中的私有資產(chǎn)也擁有重要份額，近年來(lái)還不斷增加。The 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 financi

3、ng, planning and prioritizing of health services at the national level. 衛(wèi)生與社會(huì)事務(wù)部在政治上負(fù)責(zé)并管理醫(yī)院服務(wù)，即作為全國(guó)的權(quán)威負(fù)責(zé)籌資、指定規(guī)劃，并且在國(guó)家層面上保證衛(wèi)生服務(wù)的優(yōu)先性。2Organisation of hospital services 醫(yī)院服務(wù)的管理The responsibility of providing hospital services is delegated to five Regional Health Authorities (RHA), which are organized a

4、s 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. 醫(yī)院服務(wù)的供應(yīng)職責(zé)交由五個(gè)地區(qū)的衛(wèi)生機(jī)構(gòu)(RHA)，按照中央政府所有的企業(yè)進(jìn)行管理 RHA實(shí)行國(guó)有制，在衛(wèi)生事業(yè)的政治目標(biāo)規(guī)定的框

5、架中負(fù)責(zé)為該地區(qū)人口提供衛(wèi)生服務(wù)The responsibilities also cover specialized mental-health services and hospital services to persons with drug-related health problems. 這些職責(zé)還包括特別的精神健康服務(wù)，以及為患有毒品相關(guān)健康問(wèn)題的人群提供醫(yī)院服務(wù)The production of hospital services is performed mainly by local Health Authorities (HA) owned by the RHAs or

6、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. 地區(qū)的衛(wèi)機(jī)構(gòu)(RHA)擁有的地方衛(wèi)生局(HA)以及和RHA簽訂臨時(shí)協(xié)議的私有非營(yíng)利性醫(yī)院醫(yī)院服務(wù)主要生產(chǎn)具體的醫(yī)院服務(wù)產(chǎn)品。地方衛(wèi)生局(HA)擁有一個(gè)或更

7、多的醫(yī)院。地區(qū)衛(wèi)生局在自己的產(chǎn)品之外，還從私有營(yíng)利性供應(yīng)者那里購(gòu)買(mǎi)。3Financing of hospital services 醫(yī)院服務(wù)的融資The major elements in the financing of the RHA are: 地區(qū)性衛(wèi)生機(jī)構(gòu)的主要融資因素包括：Activity-based financing; 基于醫(yī)院行為的資金In-patient and out-patiens payment schemes. 住院和門(mén)診費(fèi)用Block grants (needs-equalization grants) distributed among the RHAs acco

8、rding to socio-demographic characteristics (e.g. age-composition) of the population. 根據(jù)社會(huì)-人口特點(diǎn)（如年齡結(jié)構(gòu)）在地區(qū)的衛(wèi)生機(jī)構(gòu)中分配的整筆撥款（需求均分資助） Different ear-marked grants.不同的特殊用途的資金There is also out-of-pocket payment (user fees) for out-patient hospital services (but these finance less than 2 % of total costs). 還有患者

9、自負(fù)的門(mén)診費(fèi)用（但是此部分少于總額的2%）No out-of-pocket payments for inpatient hospital services 沒(méi)有個(gè)人承擔(dān)的住院費(fèi)用RHAs 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 a

10、uthorities a sort of population responsibility. 地區(qū)衛(wèi)生機(jī)構(gòu)可以自由選擇各自的醫(yī)院融資體系。多數(shù)地區(qū)衛(wèi)生機(jī)構(gòu)選擇“復(fù)制” 國(guó)家模式，把基于人口的資金和基于醫(yī)院行為的資金結(jié)合起來(lái)，即賦予地方衛(wèi)生機(jī)構(gòu)一定程度的人口責(zé)任。4Total health care expenditure in Norway Primary and secondary (2004) 2004年挪威初級(jí)和二級(jí)醫(yī)療衛(wèi)生總支出26 billion USD 260億美元Primary 18.5 billion 初級(jí)185億美元secondary 7.5 billion USD 二級(jí)7

11、5億美元5800 USD per person 人均5800美元9.9 % of GDP 占GDP的9.9%Public expenditure in % of total expenditure: 85.5 (2003) 公共支出占總支出的85.5% （2003年）Private expenditure in % of total: 14.5 私人支出占總支出的14.5%（2003年）Johnsen p. 325Expenditure by function, Secondary 20042004年二級(jí)支出（按不同功能分類）Inpatient and day cases of curativ

12、e care 28.6 % 住院及其每日藥品診療 Outpatient curative 17.7 % 門(mén)診治療Services of rehabilitative care 1.4 % 康復(fù)治療服務(wù)Inpatient long term nursing 15.2 % 長(zhǎng)期住院護(hù)理Homes based long term nursing care 7.5 % 長(zhǎng)期家中護(hù)理Clinical laboratory and diagnostics imaging 3.3 % 臨床實(shí)驗(yàn)和透視診斷Patient transport and emergency rescue 2.3 % 病患轉(zhuǎn)移和急救M

13、edical goods dispensed to patients 13.9 % 患者所用藥品Prevention and health administration 2.8 % 疾病預(yù)防和行政Capital formation of health care provider institutions 7.2 % 衛(wèi)生保健供應(yīng)機(jī)構(gòu)的資金份額Johnsen p. 386Private supplement 私有的補(bǔ)充部分In later years, the private supplement of hospital services has become increasingly impo

14、rtant. 近些年，私有的醫(yī)院服務(wù)日趨重要The number of private, for-profit, providers has grown. 私有營(yíng)利性供應(yīng)者數(shù)目增長(zhǎng)The range and scale of activities (out-patient and day surgery) has increased. 活動(dòng)范圍和規(guī)模增長(zhǎng)（包括門(mén)診和工作日的手術(shù)）The public providers are the major purchasers, but there is also privately financed purchases and a private h

15、ealth-insurance market is emerging. 公共供應(yīng)者仍舊是主要購(gòu)買(mǎi)者，但是私人融資的購(gòu)買(mǎi)者和私有健康保險(xiǎn)市場(chǎng)正在涌現(xiàn)7 Summary 總結(jié)Two separate management and financing systems in health care 在醫(yī)療上兩種不同的管理和融資體制Primary health: (Local) Municipality planning, implementation and financing (+ NIS) 初級(jí)衛(wèi)生保?。ǖ胤剑┦姓?dāng)局的規(guī)劃、執(zhí)行和融資（+NIS）Secondary health: 二級(jí)衛(wèi)生(National) state responsibility and financing （國(guó)家）國(guó)家職責(zé)和融資Health enterprises planning and implementing 衛(wèi)生企業(yè)規(guī)劃和執(zhí)行Primary health care: small out-of-pocket payment (12