医疗保险支付制度改革与医院成本核算发展趋势探讨

本文从医疗卫生服务供方、需方和费用支付方分析了影响医疗保险制度的因素。论述了医疗保险支付制度改革方向的特点，即医疗保险费用支付将从开放式向封闭式发展、费用支付组合从单一支付方式向多元化混合支付方式发展、医疗保险控费主体由费用控制中心向以资源控制中心发展。因此，我国现行医疗保险必须改革单一的按服务项日付费的支付方式，采取多种付费方式，并建立相应的配套措施。同时，医院医疗成本核算应建立包括科室成本核算、医疗项目成本核算和病种成本核算在内的医疗成本核算体系。

Discussion of reform in the medical insurance payment system and the development trends of hospital cost accounting

The paper analyzes from the angles of the parties providing, needing and paying for medical and health services the factors influencing the medical insurance system and discusses the features of reform directions in the medical insurance payment system, viz. the move of payment from an open to a closed mode and from a single to a mixed mode and the move of the main bodies controlling medical insurance expenses from expenses controlling centers to resources controlling centers. The single mode of payment by service procedures adopted in the current medical insurance system in China must therefore be replaced by a diversified mode of payment and corresponding supporting measures ought to be taken. In the meantime, hospital medical cost accounting ought to form a system that includes department cost accounting, medical procedure cost accounting and disease entity cost accounting.