2019年美国医院绩效评比的历程及经验教训-从犹他州卫生信息心的视角.pdf

1、美国医院绩效评比的历程及经验教训-从犹他州卫生信息中心的视角于中国医院协会信息网络大会，厦门，2019年7月6日CHIMA 2019提纲I.背景 II.现状A.民间组织的报告 B.联邦 C.州 III.经验教训及机遇与挑战?2CHIMA 2019中美健康和开的较data.worldbank.org accessed 2019.06.13?3指标中国美国出时预期命值 Life expectancy at birth,total(years)in 201776岁79岁健康开占GDP的百分 Current Health Expenditure(%of GDP)in 20165%17%政府国内健康开占

2、政府总开的百分 Domestic general government health expenditure(%of general government expenditure)in 20169%39%CHIMA 2019美国政府参与医院绩效评比的起因 上世纪年代后，医疗开呈指数型增长趋势 政府的医疗经济负担越来越重 医疗付费模式从“Fee for Service”按服务量付费 转变到“Managed Care”管理下的治疗，医疗体制和业也发变化，进对政府的职能提出新要求?4CHIMA 2019七个西方国家医疗费用增长美国CHIMA 2019美国医保开的增长?6https:/www.heal

3、thsystemtracker.org/interactive/?display=U.S.%20$%20Billions&service=Hospitals,Physicians%20%26%20Clinics,Prescription%20DrugMedicare 联邦政府年（65+）医疗保险Medicaid 联邦和州政府低收群医疗保险Private 私商业医疗保险（雇主为雇员买）CHIMA 2019医疗保险业的经济影响?7THE NATIONS HEALTH DOLLAR($3.5 TRILLION),CALENDAR YEAR 2017:WHERE IT CAME FROMInvestm

4、ent,5%Other Third Party Payers and Programs 1,8%Government Public Health Activities,3%Out of Pocket2,10%Health Insurance,75%Medicare,20%Private Health Insurance,34%Medicaid(Title XIX)Federal,10%Medicaid(Title XIX)State and Local,6%VA,DOD,and CHIP(Titles XIX and Title XXI),4%1 Includes worksite healt

5、h care,other private revenues,Indian Health Service,workers compensation,general assistance,maternal and child health,vocational rehabilitation,Substance Abuse and Mental Health Services Administration,school health,and other federal and state local programs.2Includes co-payments,deductibles,and any

6、 amounts not covered by health insurance.Note:Sum of pieces may not equal 100%due to rounding.SOURCE:Centers for Medicare&Medicaid Services,Office of the Actuary,National Health Statistics Group.医疗保险业付75%的全美医疗开商业医保付45%的全美医保开医保付27%的全美医保开穷医保付21%的全美医保开CHIMA 2019质量和费用与美国的医疗改革 Improve Access 增加医保覆盖（政府负责）