摘要
目的:探讨医联体医保总额付费基金的测算方法及可行性。方法:以某区域医联体为例,通过按人头、按服务单元(次均费用)以及按住院指数单价三种测算方法对区域医保总额进行测算,并对测算结果进行比较分析。结果:按人头付费使得医联体医保总额增量最大,有利于调动医联体积极性;按服务单元(次均费用)和住院指数单价测算考虑到了区域内不同医疗机构的资源配置差异和历史水平因素,更利于发挥医保对医疗服务供需双方的引导作用和医疗费用的控制作用。结论:单纯测算医保总额预付额度只是开展医联体医保支付方式改革的基础,更为重要的是发挥医保支付方式在医联体内部的指挥棒作用,促进医联体整体效率和公平的提升。
Objective： To research on the method and accessibility of budgeting for the basic medical insurance scheme in medical union. Methods： The budget of the basic medical insurance scheme of an urban medical union was calculated by capita, service unit（average expenditure per visit） and hospitalization index. Calculation results of each method were compared and analyzed. Results： Bxidgeting by capita increased the total amount largely, which helped mobilizing the enthusiasm of the medical union. Considering the resource allocation differences and historical level factors of different regional medical institutions by service unit（average cost） and single hospitalization index price,would help the medical insurance’s lead on supply side and demand side of medical services and the its control on medical expenses. Conclusion： Calculation of the medical insurance budget was only the basis of payment reform of medical union. It was more important to leverage different payment methods in the medical union to improve the overall efficiency and equity of the medical union.
作者
王力男
朱碧帆
胡善联
WANG Li-nan;ZHU Bi-fan;HU Shan-lian(Shanghai Health Development Research Center,Shanghai 200031,China;School of Public Economics and Administration,Shanghai University of Finance and Economics,Shanghai,200433,China)
出处
《中国卫生经济》
北大核心
2018年第11期20-23,共4页
Chinese Health Economics
基金
美国中华医学基金会卫生体系研究与政策转化合作项目(CMB-CP 14-190)
关键词
城市
区级医疗联合体
医保支付
总额付费
urban area
district medical union
medical insurance payment
total amount payment
