醫(yī)院的作業(yè)融資系統(tǒng)及管理層與醫(yī)生的相互影響【外文翻譯】

1、本科畢業(yè)論文（設(shè)計）外文翻譯原文：原文：Hospital’sactivitybasedfinancingsystemmanagerphysicianinteraction1、IntroductionThreemainissuesassociatedtohospitalfinancingsystemaremostlyconsideredintheeconomicliterature.Namelytheabilitytocontrolthe

2、totalcosttoinduceefficiency(minimalunitcostmaximallevelofactivitybyunitofinput)toensureahighlevelofthequalityofcaredelivered.Amongindustrializedcountriesuntilthe1980scostreimbursementwasthemainfmofpaymentfpublicprivateno

3、tfprofithospitals.Whileitallowsfhighqualityofcarethissystemneitheroffersincentivestoreducecostsntoincreaseefficiency.Intheearly1980spolicymakersbegantoconsidertheswitchfromthecostbasedreimbursementtoprospectivebudgetstoc

4、opewithcontinuouslyincreasinggrowthofhospitalspendingthiscappedhospitalexpenditureatanexogenousgrowthrate.Whilethissystemallowsfcostcontainmentitiscompletelydisconnectedfromtherealactivityofhospitalscreatesnoincentivesfe

5、fficiencyahighlevelofqualityofcare.Ontheotherhtheprivatefprofithospitalsweretraditionallyfinancedonafeefservicebasis.FinallyinthelastdecademostoftheOECDcountriesjoinedtheUSwhohadinitiatedanactivitybasedpaymentfbothpublic

6、privatehospitalsasearlyasin1983ftheMedicareprogram.Thisactivitybasedsystemwksonaflatamountperadmissiongiventhepatient’sdiagnosisthusencouragesthehospitaltoloweritsunitcostindertoturnaprofit.Clearlythisactivitybasedpaymen

7、tcreateshugeincentivesfefficiency.Actuallymostcountriesoptfamixoffinancingsystemswherestrongincentivesareplacedonefficiencybytheactivitybasedsystemwhileexternalcontrolsensureanexpectedlevelonthequalityofhealthcareservice

8、saglobalexpenditurecappolicyaimstocontainthetotalspending.shouldbepromotedbyanactivitybasedfinancingsystem.Wealsoextendtheanalysistothepublicsectsincebothbehavisobjectivesdifferamongphysiciansmanagersinthetwosects.Meover

9、currentfinancingsystemarequitedifferent(prospectivebudgetsalariedphysiciansinthepublicsectfeefservicefboththehospitalphysiciansintheprivatesect).Ourmainfocusishowthetransitiontoacommonactivitybasedfinancingschememayaffec

10、tdifferentlypublicprivatehospitalshowitmaymodifythetypeofinteractionsbetweenhospital’smanagersphysiciansdependingtheyhaveconflictinginterestsincentivestocooperateunderthenewpaymentsystem.Sincewearemainlyinterestedinthemo

11、dificationofthebehaviweconsideraneutralfinancingrefmwhichdoesnotaffecttheamountoftheglobalbudgetbutonlythereimbursementschemes.2、FinancingsystemspublichospitalsThissectionanalysestheimpactoftheintroductionofanactivitybas

12、edpaymentsystemonthenumberofactsundertakendailybyphysiciansonthelengthofstayontheinputinvestedwithinpublichospitals.Theinitialrevenuegrantedtopublichospitalswasunliketherevenuegrantedtoprivatehospitalsaprospectivebudgeti

13、ndependentofboththenumberofpatientsthelengthofstay(seethebudgetconstraint(4)).Thepoliticalwilltoharmonizefinancingsystemsacrossalltypeofhospitals(fprofitnotfprofit)therefeimpliesthatthetransitiontotheactivitybasedpayment

14、systemisnotsimilarbetweenprivatepublichospitals.Theactivitybasedpaymentsystemgiveshoweveranindirectincentivetoreducethepatients’lengthofstaysincethefinancingdependsonthedemD(eq).Weshowthattheimpactofanactivitybasedpaymen

15、tsystemonthepublichospital’sequilibriumvaluesofeqdependsontheelasticityofdemwithrespecttotheinput(inputelasticityofdem).Wefirstexaminehowthetransitionfromaprospectivebudgetsystemtoanactivitybasedpaymentsystemaffectsthede