Aas I H
Kursledare i hälsooch sjukvårdsadministration, Nordiska Hälsovårdshögskolan, Göteborg.
Nord Med. 1994;109(5):140-3.
Financing methods for health care have great actuality in the Nordic countries. Incentive theory background is briefly presented. The main categories and subcategories of financing methods are listed. For the global budget solutions capitation and global budget based on historical costs, the advantages and problems are discussed. The two main categories per-case reimbursement, retrospective and prospective, are presented. The retrospective category includes per-diem rates and fee-for-service payment. Prospective reimbursement can be done on the basis of product definitions or episodes of care. The possibility of result grading the per-case reimbursement is mentioned. Problem solving by hybrid methods of financing is presented. Requirements to reimbursement methods can be: 1) They should be clinically neutral or assist in reaching formulated goals. 2) They should not result in unwanted use of any level of care. 3) They should not present barriers to justified referral between any level of care.
医疗保健融资方法在北欧国家具有重大现实意义。简要介绍了激励理论背景。列出了融资方法的主要类别和子类别。对于全球预算解决方案（按人头付费和基于历史成本的全球预算），讨论了其优点和问题。介绍了按病例报销的两个主要类别，即回顾性和前瞻性。回顾性类别包括每日费率和按服务收费。前瞻性报销可以基于产品定义或护理事件进行。提到了对按病例报销进行结果分级的可能性。介绍了通过混合融资方法解决问题的情况。对报销方法的要求可以是：1）它们应在临床上保持中立或有助于实现既定目标。2）它们不应导致对任何护理级别的不必要使用。3）它们不应在任何护理级别之间的合理转诊方面造成障碍。
