Chawla Mukesh, Berman Peter, Windak Adam, Kulis Marzena
The World Bank, Washington, DC, USA.
Soc Sci Med. 2004 Jan;58(2):227-35. doi: 10.1016/s0277-9536(03)00006-6.
This study provides a comprehensive picture of the organization and delivery of ambulatory health care services in Poland. A main finding of the study is that, following the introduction of health insurance in 1999, the newly introduced Sickness Funds have become the main players in the medical services market, introducing new bidding procedures and contracts for provision of medical services. Contracts, and negotiations which precede them, have introduced elements of market competition, which has affected the number and types of services provided by health care centers operating under a contract. The health financing reforms have led to an even playing field for public and non-public providers, marked by a proliferation of structurally smaller health units. The introduction of a market environment has changed the way in which providers are compensated, with a discernible shift away from salary-based systems to capitation and fee-for-service compensation. The analysis of the provider market for outpatient care underscores the importance of understanding the organization and supply of health services, particularly insofar as it relates to the design of appropriate financial and other incentives for providers of health services and of policy interventions necessary for achieving systemic changes.
本研究全面呈现了波兰门诊医疗服务的组织与提供情况。该研究的一个主要发现是，自1999年引入医疗保险后，新设立的疾病基金已成为医疗服务市场的主要参与者，引入了新的医疗服务提供招标程序和合同。合同以及合同签订前的谈判引入了市场竞争元素，这影响了按合同运营的医疗保健中心所提供服务的数量和类型。卫生筹资改革为公立和非公立医疗服务提供者创造了公平的竞争环境，其特点是结构上规模较小的卫生单位大量涌现。市场环境的引入改变了医疗服务提供者的薪酬支付方式，明显从基于工资的体系转向按人头付费和按服务收费的薪酬方式。对门诊医疗服务提供者市场的分析凸显了理解卫生服务组织和供应的重要性，特别是在涉及为卫生服务提供者设计适当财务及其他激励措施以及实现系统性变革所需政策干预方面。
