| 摘要: |
| 医保支付方式改革是医药卫生体制改革的重要抓手，也是形成“运行新机制”的必要措施，而实现收付费一体化与协同则是深化医保支付方式改革的必然要求。这不仅有利于提高医保基金的使用效率，也有利于从制度上减轻患者的经济负担。文章主要以DRG收付费为例，分析我国收付费协同的医保支付方式改革现状。研究发现：我国在开展的医保支付方式改革中，大多数地区只做到医保付费端，而医院收费端仍是按项目收费，即采用的是“收费”与“付费”并行的双轨制管理办法。尽管我国有福建省三明市等少部分地区逐步开展了收付费协同的医保支付方式改革探索，但“收—付”两端的协同改革仍须强化，同时“政策组合拳”的跟进也至关重要。 |
| 关键词: 医疗保险 支付方式改革 收付费一体化 收付费协同 |
| DOI： |
| 投稿时间：2023-06-13 |
| 基金项目:贵州省哲学社会科学规划课题资助 （22GZYB69） |
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| Current Situation and Development Trend of Medical Insurance Payment Reform Based on Pricing and Payment Coor⁃ dination in China |
| Feng Yi |
| (School of Administration, Zunyi Medical University, Zunyi, Guizhou, 563000 , China) |
| Abstract: |
| The reform of the medical insurance payment method is an important step in the reform of medical and health care sys- tem, and a necessary measure to form a“new operating mechanism”. To realize the integration and coordination of pricing and pay- ment is an inevitable requirement for deepening the reform of the medical insurance payment mechanism. This is not only conducive to improving the efficiency of the use of medical insurance funds, but also conducive to ensuring that the system will not increase the personal economic burden of patients. DRG is taken as an example to analyze the current situation of the collaborative reform of pric- ing and payment in the process of implementing DRG in China. It is found that in the reform of payment methods carried out in Chi- na, most regions only achieved the payment end of medical insurance, while the hospital charge end was still pay for service, that is, the dual track management of“pricing”and“payment”is adopted. Although a small number of regions, such as Sanming City, Fuji- an Province, have gradually carried out the exploration of payment reform based on pricing and payment coordination, the col- laborative reform of both ends of pricing and payment in China still needs to be strengthened, and the follow-up of the policy portfo- lio is also critical. |
| Key words: medical insurance payment mechanism reform pricing and payment integration pricing and payment coordination |
