不同医疗卫生机构的基本医疗保险支付方式选择模式探究

基于不同基本医疗保险支付方式的利弊分析、借鉴国外典型国家基本医疗保险支付方式,结合国内医疗卫生机构基本医疗保险支付方式的成功经验,探究不同医疗卫生机构的基本医疗保险支付方式选择模式。建议针对基层医疗卫生服务机构,采用总额预付制或按人头付费为主的方式;针对二级、三级综合医院,采用总额预付制为基础的,按病种付费为主,结合按人头付费、按服务项目付费和按床日付费等支付方式的医保支付模式;专科医院,采用总额控制下按病种付费和按床日付费相结合的支付模式。

Study on the payment mode of basic medical insurance in different medical and health institutions

Based on the analysis of the advantages and disadvantages of different payment modes of basic medical insurance,drawing lessons from the payment modes of basic medical insurance in typical foreign countries,and combining the successful experience of payment modes of basic medical insurance in domestic medical and health institutions,this paper explores the payment modes of basic medical insurance in different medical and health institutions. For grass-roots medical and health service institutions,it is suggested to adopt total prepaid amount system or per capita payment as main payment method. For secondary and tertiary general hospitals,we suggest that total prepaid amount system be adopted as the basis,and the payment according to disease type as main payment method,combined with per capita payment,service item payment and bed-day payment. For specialied hospitals,we propose to adopt the payment mode of combining disease type payment and bed-day payment under total amount control.