医院管理与融资

1、1Organisation and financing of hospital services in Norway 挪威医院服务的管理和融资In Norway, the financing and provision of hospital services is mainly a public responsibility, financed by income and wealth taxation. But one can also find a significant private contribution in terms of both financing and provis

2、ion, which has become more important in recent years. 在挪威，医院服务的筹资和供应基本上是一项公共职责，由所得税和福利税负担。但是筹资和供给中的私有资产也拥有重要份额，近年来还不断增加。The political responsibility and control of hospital services lies with the Ministry of Health and Care Services, i .e. the national health authority is responsible for the financi

3、ng, planning and prioritizing of health services at the national level. 卫生与社会事务部在政治上负责并管理医院服务，即作为全国的权威负责筹资、指定规划，并且在国家层面上保证卫生服务的优先性。2Organisation of hospital services 医院服务的管理The responsibility of providing hospital services is delegated to five Regional Health Authorities (RHA), which are organized a

4、s central governmentally-owned enterprises. The RHA exercises state ownership and has the responsibility for providing services to the population in the health region, within the framework stated by the overall health political goals. 医院服务的供应职责交由五个地区的卫生机构(RHA)，按照中央政府所有的企业进行管理 RHA实行国有制，在卫生事业的政治目标规定的框

5、架中负责为该地区人口提供卫生服务The responsibilities also cover specialized mental-health services and hospital services to persons with drug-related health problems. 这些职责还包括特别的精神健康服务，以及为患有毒品相关健康问题的人群提供医院服务The production of hospital services is performed mainly by local Health Authorities (HA) owned by the RHAs or

6、with private, non-profit, hospitals that have a provisional agreement with the RHA. The local HA consists of one or more hospitals. The RHA supplements its own production with purchases from private, for-profit, providers. 地区的卫机构(RHA)拥有的地方卫生局(HA)以及和RHA签订临时协议的私有非营利性医院医院服务主要生产具体的医院服务产品。地方卫生局(HA)拥有一个或更

7、多的医院。地区卫生局在自己的产品之外，还从私有营利性供应者那里购买。3Financing of hospital services 医院服务的融资The major elements in the financing of the RHA are: 地区性卫生机构的主要融资因素包括：Activity-based financing; 基于医院行为的资金In-patient and out-patiens payment schemes. 住院和门诊费用Block grants (needs-equalization grants) distributed among the RHAs acco

8、rding to socio-demographic characteristics (e.g. age-composition) of the population. 根据社会-人口特点（如年龄结构）在地区的卫生机构中分配的整笔拨款（需求均分资助） Different ear-marked grants.不同的特殊用途的资金There is also out-of-pocket payment (user fees) for out-patient hospital services (but these finance less than 2 % of total costs). 还有患者

9、自负的门诊费用（但是此部分少于总额的2%）No out-of-pocket payments for inpatient hospital services 没有个人承担的住院费用RHAs are free to choose their own system of hospital financing. Most RHAs have chosen to ”copy” the national model combining population-based grants with activity-based financing, i.e. giving the local health a

10、uthorities a sort of population responsibility. 地区卫生机构可以自由选择各自的医院融资体系。多数地区卫生机构选择“复制” 国家模式，把基于人口的资金和基于医院行为的资金结合起来，即赋予地方卫生机构一定程度的人口责任。4Total health care expenditure in Norway Primary and secondary (2004) 2004年挪威初级和二级医疗卫生总支出26 billion USD 260亿美元Primary 18.5 billion 初级185亿美元secondary 7.5 billion USD 二级7

11、5亿美元5800 USD per person 人均5800美元9.9 % of GDP 占GDP的9.9%Public expenditure in % of total expenditure: 85.5 (2003) 公共支出占总支出的85.5% （2003年）Private expenditure in % of total: 14.5 私人支出占总支出的14.5%（2003年）Johnsen p. 325Expenditure by function, Secondary 20042004年二级支出（按不同功能分类）Inpatient and day cases of curativ

12、e care 28.6 % 住院及其每日药品诊疗 Outpatient curative 17.7 % 门诊治疗Services of rehabilitative care 1.4 % 康复治疗服务Inpatient long term nursing 15.2 % 长期住院护理Homes based long term nursing care 7.5 % 长期家中护理Clinical laboratory and diagnostics imaging 3.3 % 临床实验和透视诊断Patient transport and emergency rescue 2.3 % 病患转移和急救M

13、edical goods dispensed to patients 13.9 % 患者所用药品Prevention and health administration 2.8 % 疾病预防和行政Capital formation of health care provider institutions 7.2 % 卫生保健供应机构的资金份额Johnsen p. 386Private supplement 私有的补充部分In later years, the private supplement of hospital services has become increasingly impo

14、rtant. 近些年，私有的医院服务日趋重要The number of private, for-profit, providers has grown. 私有营利性供应者数目增长The range and scale of activities (out-patient and day surgery) has increased. 活动范围和规模增长（包括门诊和工作日的手术）The public providers are the major purchasers, but there is also privately financed purchases and a private h

15、ealth-insurance market is emerging. 公共供应者仍旧是主要购买者，但是私人融资的购买者和私有健康保险市场正在涌现7 Summary 总结Two separate management and financing systems in health care 在医疗上两种不同的管理和融资体制Primary health: (Local) Municipality planning, implementation and financing (+ NIS) 初级卫生保健（地方）市政当局的规划、执行和融资（+NIS）Secondary health: 二级卫生(National) state responsibility and financing （国家）国家职责和融资Health enterprises planning and implementing 卫生企业规划和执行Primary health care: small out-of-pocket payment (12