服务购买视角下医疗保险总额预付的内涵和机制分析

探索总额预付是现阶段推进医保支付方式改革的核心任务之一。根据医疗服务购买理论，在我国当前医改背景下，除费用控制外，总额预付更应以提高服务绩效为设计目标。在总额预付预算及结算阶段各管理要素下进行不同的机制设计会对医疗费用、服务效率和质量产生不同影响，因此，本文在上述分析基础上，提出了将患者自付费用纳入总额预付控制范围、按绩效评估与支付等规范总额预付的建议。

The implications and mechanisms of global budget from the perspective of healthcare purchasing

This article revisits the goals and implications of the global budget, one of the major provider payment reform policies in China. This article is based on the theory of health purchasing and points out that the intention of global budget mechanism is to improve healthcare performance and not merely contain medical costs. It then analyses the mechanisms and effectiveness of each element of global budgeting process on cost, efficiency, and quality in order to draw some conclusions about normative development of this payment method reform in practice.