住院医疗费用总额预付制结算办法及其运行效果评价

近年来,我国医疗费用快速增长,其中住院医疗费用的增长更快。随着新医改的推进,各地都在积极探索医疗费用的控制方法。江苏省W市医疗保险基金管理中心制定了住院费用总额预付标准,对医疗保险定点医疗机构的年度住院费用进行总额控制,对定点医院参保人员住院费用实行"总额控制、按月结付、超支分担、节余留成"的结算办法。该办法对控制住院医疗费用的快速增长,减轻参保人的医疗费用负担起到了积极的作用。在详细调查了W市定点医疗机构住院医疗费用预付总额制定办法的基础上,对其合理性、存在问题以及运行效果进行了评价,并提出了完善这一办法的建议。

Settlement method of total prepaid and its operation evaluation for inpatient expenditure

In recent years,medical costs rising fast,which inpatient expenditure rising even more seriously. With the progresses of new health reform,many places explore ways to actively control medical costs actively. The medical insurance fund management center in W City of Jiangsu Province developed the prepaid standards of total costs for designated hospital to control its annual inpatient costs. The inpatient expenses for the insured person at the designated hospital was used the settlement approach of ＂total control,a monthly statement to pay,cost overruns-sharing,saving retained＂. This approach played an active role in controlling the rapidly rising of inpatient costs,which reduced the insured person＇s burden on the medical expenses. On the basic of detailed investigation of the developping ways of total prepaid for hospital expenses at the designated medical institutions in that city,this article evaluated the rationality,problems and running effect of its ways to develop the total prepaid method,and made some recommendations to improve it.