深圳市医疗保险服务结算办法

深圳市医疗保险经历了三个阶段，各阶段采取的费用结算办法不同。第一阶段实行门诊人次费用定额、住院床日费用定额和住院天数定额的偿付办法，并对某些专科实行按病种付费，对企事业医务所实行按人头付费的办法。第二阶段的费用结算有两大特点：一是个人医疗帐户与共济帐户分开使用，有条件的设通道；二是住院多种结算办法并用。第三阶段取消对“特殊病种”住院费用单独偿付、实报实销的办法，对平均住院费用标准作了相当幅度的调整；确定了基本医疗界线、范围和标准，确定了费用限额；进一步完善了对供方的制约机制。经过三个阶段的探索，深圳市医疗保险结算办法逐渐走向合理化、科学化、规范化。

Accounting approaches for medical insurance service in shenxhen

Three schemes of accounting approaches for medical insurance have been developed and implemented in Shengzhen in different periods of time. The first one was to allocate a fixed amount to hospital by the number of outpatient visits and the days of occupation of the hospital beds by in patients. Additionally,in certain special departments,the payment was fixed according to different kinds of the diseases. For the medical institution of the enterprise ,an accounting system based on the number of employee was used. The second one had two significant changes for the accounting approaches. One was the personal account book separating from the general account book and a conditional path was established. The other one was to combine various accounting approaches for in patients. The third scheme is now in use. It rules out the special account for peculiar diseases,which reimburses according to the actual expenditure. The average expense of in patients within the system was adjusted to a considerable extent. The concept of basic medical care and its scope and the maximum expense was defined. Through the investigation and practice, the accounting approaches for medical insurance in Shengzhen municipality have been gradually stepped into a status of rationalization,scientific administration and standardization.