引用本文: 廖冬平,兰珍,刘婧,等.医保打包支付对紧密型医共体运营管理的影响研究*[J].中国卫生经济,2023,42(5):29-33.[点击复制] LIAO Dong-ping,LAN Zhen,LIU Jing,et al.Research on the Impact of Medical Insurance Package Payment for Merged County Medical Alliance[J].CHINESE HEALTH ECONOMICS,2023,42(5):29-33.[点击复制]
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医保打包支付对紧密型医共体运营管理的影响研究*
廖冬平,兰珍,刘婧,郑凌云,任雯
0
(三明市第二医院(三明市永安总医院)福建 三明 366000)
摘要:
紧密型医共体建设与医保打包支付改革都是“以人民健康为中心”的创新举措,一个是体制的保障,一个是机制的突破。三明市12家紧密型医共体实行医保基金总额包干与C-DRG收付费相结合,实现医保支付“双打包”。通过医保支付改革与医共体相关政策分析,结合2017—2021年三明市12家紧密型医共体的运行数据,以医保基金结余、C-DRG执行情况、医疗收入结构、医院职工收入、患者次均费用、平均住院日及住院报销比例等指标作为评价维度,深入评估医保打包支付改革对于紧密型医共体运行管理的影响,在此基础上,以业务量下滑明显但成效较好的永安医共体为研究样本,进一步探究医保打包支付改革对紧密型医共体运营管理的内在影响机制,从而提出优化紧密型医共体运营管理的政策建议。
关键词:  紧密型医疗共同体  医保打包支付方式改革  按疾病诊断相关分组收付费
DOI:
投稿时间:2023-02-05
基金项目:2022年度卫生健康政策创新研究课题项目(2022A04)
Research on the Impact of Medical Insurance Package Payment for Merged County Medical Alliance
LIAO Dong-ping,LAN Zhen,LIU Jing,ZHENG Ling-yun,REN Xia
(Sanming Second Hospital (Yong' an General Hospital), Sanming, Fujian, 366000 , China)
Abstract:
Both the construction of merged medical alliance and medical insurance payment reform are innovative measures of "taking residents' health as the center",reflecting the guarantee of the system and the breakthrough of the mechanism. The 12 merged county medical alliances in Sanming City implement the combination of lump sum contracting and C-DRG collection and payment fees to achieve the "double package" of medical insurance payment. Through the analysis of the medical insurance payment reform and the relevant policies of the medical community,combined with the operating data of the 12 merged county medical alliances in Sanming City from 2017 to 2021,the impact of the medical insurance payment reform on the operation and management of the tight medical community were deeply evaluated by taking the medical insurance fund balance,the C-DRG implementation,hospital income structure,hospital staff income,average cost per visit,average length of stay,hospitalization reimbursement ratio and other indicators as the evaluation dimensions. On this basis,Yongan Medical Community with obvious decline in business volume but good results was taken as the research sample,to further explore the internal impact mechanism of medical insurance payment reform on the operation and management of merged county medical alliance,so as to put forward policy recommendations to optimize the operation and management of merged county medical alliances.
Key words:  merged medical alliance  medical insurance payment reform  Chinese Diagnosis Related Groups

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