新型农村合作医疗支付制度研究

新农村合作医疗制度在运行中因医疗费用过快增长和基金被过度消耗而影响其健康运行,而支付制度是控制医疗费用增长的关键,支付制度的缺陷直接影响"新农合"健康运行。在国外行之有效的付费制度,在中国农村的实践中遭遇了严峻的挑战。文章在支付制度本身和政策、法律环境等实施环境方面分析缺陷产生的原因,借鉴美、德、日及巴西、泰国的农村医疗保险实施的成功经验,提出选择引入昏迷分级、DRGs、病人管理分组等辅助度量工具的按人/次门诊支付和按服务项目支付、有起付线和封顶线、固定自负比例相结合住院支付的混合型支付制度的建议,并在法律和政策上相应完善。

Study on Payment System in the New Rural Cooperative Medical Care

The new rural cooperative medical system has a problem that the medical expenses grow too fast and its fond consumes excessively,so it cannot run in a healthy way.Payment system is the key of controlling medical expenses to growth.So the payment system deficiency threats the new rural cooperative medical system’s healthy operation.Different payment systems have new problems that cannot reach its goal when using in the new rural cooperative medical care.The paper analyzes reasons from the payment system itself and legal,medical policy environment with reference to successful experience of America,German and Brazil,etc,and chooses the mixed payment systems.The people-time prospective payment with coma classification,DRGs and patient management group uses in outpatient service,while fee-for service with the lowest and highest line and fixed ratio payment system in hospitalization though taking measures to perfect legal,medical policy environment to ensure its implementation.