以价值为导向的医保支付制度实施路径

价值医疗权衡医疗成本与所获健康结果之间的关系,关注的是整体健康结果。医保支付制度需要以价值为导向,以经济为杠杆,引导服务提供方以最小的成本产生最优的医疗服务。微观上,对单家机构实施以疾病诊断相关分组和病种分值付费为主的多元支付制度;中观层面,探索捆绑支付、以结果为导向的多方风险共担机制;宏观上,实行医联体内的总额预付。通过探索适用于当前中国医疗服务特点的以价值为导向的医保支付制度,提高医疗机构内在动力,优化就诊结构,最终实现整体健康水平的提升。

The Implementation Path of Value-oriented Medical Insurance Payment System

The value-based medicine weights the relationship between medical costs and health outcomes,focusing on the overall health outcomes.Medical insurance payment system needs to be value-oriented and economic-leveraged to guide service providers to produce optimal medical services at minimum cost.On the micro level,it implement a single institution based on disease diagnosis-related groups and disease based score multiple payment system;on the meso-level,it explore bundled payment,result-oriented of multiparty risk-sharing mechanism;macroscopically,it implement the global budget payment in the medical alliance By exploring the value-oriented medical insurance payment system which is suitable for the current medical service characteristics in China,it can improve the internal motivation of medical institutions,optimize the visit structure,and finally achieve the improvement of the overall health level.