Abstract:

China is facing both the rapid growth of medical expenses and challenge of quality care. Paying for quality for healthcare providers used by international healthcare systems has proven to be effective in solving the problems. We systematically reviewed the UK Quality and Outcomes Framework (QOF) , a typical case of paying for quality, with a description of its content, effectiveness of implementation and future prospect, which may have implications for China's healthcare payment system. We analyzed the applicable feasibility of paying for quality in China's healthcare payment system using the policy analytical framework in accordance with China's political, technological, economic and administrative conditions, and suggested that paying for quality may have a good application prospect but with limitations for fully implementation. In the future, it could be first used as a payment method for chronic disease outpatient care or Chinese medicine services as a pilot program, and integrated into the multiple composite medical insurance payment system, and applied to other fields exploratorily.

Key words: Paying for quality, Quality and Outcome Framework, Policy scheme analysis framework, Health care reform, United Kingdom

摘要：

医疗费用快速增长和医疗质量欠佳是当前中国面临的两大问题，从国际经验来看按质量支付是解决这两大问题的有效尝试。本文以英国的质量与结果框架（QOF）为典型案例，系统说明了英国按质量支付的内容、实施效果及未来走向，旨在为中国支付方式改革提供经验借鉴。本文利用政策方案分析框架，从政治、技术、经济、行政4个方面分析了中国情境下推行按质量支付的可行性，认为按质量支付在中国应用的前景良好但目前仍缺乏大范围推广的条件，未来可以先在门诊慢性病和中医药支付中试点，将按质量支付有机融入多元复合式医保支付体系并不断探索其应用领域。

关键词: 按质量支付, 质量与结果框架, 政策方案分析框架, 卫生保健改革, 英国