医保基金总额预付制的政策性思考

我国医改已进入深水区,医保基金付费模式的改革更是涉及诸多政策规定。虽然医保基金总额预付制已被广泛采用,但要确保其运转可靠和支付高效,仍需要在各方权益中找到平衡点,把管控的重点转移到诊疗总费用上,并寻求与相关医改政策的衔接配套,才能有利于形成多元组合、配套的总额预付制支付模式,进而助力医改政策的不断完善。

Discussion on Total Prepaid System of Health Insurance Funds

The reform of the health insurance fund payment mode involves many policies. Although health insurance funds total prepaid system has been widely adopted, but to ensure the reliable and efficient of its operation, we should still need to find the balance point of the interests of all parties, and the focus should be put on the management and control of the total cost of the clinic and seek convergence facilities of the relevant medical reform policy, thus to form a diversified, matching total amount prepaid payment mode, and advance the continuous improvement of the medical reform policies.