Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan.
Int J Health Policy Manag. 2015 Feb 6;4(2):57-9. doi: 10.15171/ijhpm.2015.26. eCollection 2015 Feb.
Co-opting physicians to regulate Fee-for-Service (FFS) payment is more feasible and simpler to administer than capitation, Diagnosis-Related Groups (DRGs) and pay-for-performance. The key lies in designing and revising the fee schedule, which not only defines and sets the fee for each item, but also the conditions of billing. Adherence to these regulations must be strictly audited in order to control volume and costs, and to assure quality. The fee schedule requires periodic revisions on an item-by-item basis in order to maintain balance among the providers, to list new drugs, devices and equipment, and to reflect the lower market prices of existing ones. Implementing the fee schedule will facilitate the control of balance billing and extra billing, and the introduction of more sophisticated methods of payment in the future.
将医师纳入到管理按服务项目收费(FFS)的体系中,比管理总额预付制、按疾病诊断相关分组(DRGs)和按绩效付费更为可行,也更为简单。关键在于设计和修订收费表,这不仅要定义和设定每个项目的收费,还要设定计费条件。为了控制数量和成本,并保证质量,必须严格审核这些规定的执行情况。收费表需要按项目逐项定期修订,以维持提供者之间的平衡,列入新的药品、器械和设备,并反映现有药品的较低市场价格。实施收费表将有助于控制按项目收费和额外收费,并为未来引入更复杂的支付方式提供便利。