摘要
建立健全职工医保门诊共济保障机制,为促进分级诊疗制度建设提供了契机。门诊共济保障改革可以实现对参保职工门诊就医行为的规范、间接调整住院服务行为,同时对城乡居民医保形成示范和带动作用。为促进分级诊疗制度建设,职工医保门诊共济保障改革需要确立与分级诊疗政策导向一致的改革目标,并优化补偿方案、实行打包付费、明确病种目录、树立健康导向,从供需双方同时发力推进分级诊疗秩序的形成。同时,还需采取扩大定点范围、调整药品政策、明确技术标准、强化质量监管等配套措施,确保分级诊疗制度建设能够落到实处。
The establishment and improvement of the medical insurance outpatient co-ordination service mechanism provides an opportunity to promote the construction of hierarchical diagnosis and treatment system.The reform of outpatient co-ordination can standardize the outpatient medical behavior of insured employees,indirectly adjust the inpatient service behavior,and form a demonstration and driving role for urban and rural residents'medical insurance.In order to promote the construction of hierarchical diagnosis and treatment system,the reform of employee medical insurance outpatient co-ordination needs to establish the reform goal consistent with the hierarchical diagnosis and treatment policy orientation,optimize the compensation scheme,implement package payment,clarify the disease category list,establish health orientation,and promote the formation of hierarchical diagnosis and treatment order from both sides of supply and demand at the same time.At the same time,we need to expand the scope of fi xed points,adjust drug policies,clarify technical standards,strengthen quality supervision and other supporting measures to ensure the implementation of the hierarchical diagnosis and treatment system.
作者
傅卫
赵东辉
Fu Wei;Zhao Donghui(Health Development Research Center Of National Health Commission,Beijing,100044;School of Labor and Personnel,Renmin University of China,Beijing,100872)
出处
《中国医疗保险》
2020年第12期17-22,共6页
China Health Insurance
关键词
职工医保
门诊共济保障改革
分级诊疗
urban employees’basic medical insurance
reform of outpatient co-ordination
Hierarchical diagnosis and treatment
