为医保收支平衡提供稳定的环境：“总额预算＋按服务单元付费”组合支付方式预期效果之五  

Expected effects of the mixed payment of"Global budget and Service unit"(Ⅴ):providing a balanced environment between financing and expenditures for insurance fund

作　　者：曾雁冰[1] 吕军[1] 王颖[1] 孙梅[1] 励晓红[1] 苌凤水[1] 高解春 汤善健[3] 郝模[1] 

机构地区：[1]复旦大学卫生发展战略研究中心,上海200032 [2]上海申康医院发展中心,上海200041 [3]复旦大学数学科学学院,上海200433

出　　处：《中国卫生资源》2011年第1期35-36,共2页Chinese Health Resources

基　　金：国家自然科学基金重点项目基金资助,项目编号:70733002;“长江学者特聘教授”项目基金资助;教育部2009年度创新团队项目基金资助,项目编号:IRT0912;教育部哲学社会科学研究重大课题攻关项目基金资助,项目编号:07JZD0017;国家社会科学青年项目基金资助,项目编号:08CZZ022

摘　　要：从组合支付方式设计原理出发,利用我国常规统计数据进行论证,发现"总额预算+按服务单元付费"组合支付方式下,明确设立医疗机构业务收入的总额及按GDP同步增长的增速指标,医疗费用支出可预测、可调控,能确保医保费用支出与筹资基本同步,为医保基金收支平衡提供稳定的环境。另外,由于对每次服务实行定额收费,所以易于与医保给付方式接轨,收支平衡补偿方案容易制定。由此,医疗保障部门担忧的收支失衡问题得以彻底解决。According to the design principle of the payment,through qualitative analysis and quantitative simulation by conventional statistical report data,the paper discovered that under the mixed payment of ＂ Global budget and Service unit＂,the total amount of operating revenue of hospitals is fixed and allowed to increase with GDP.Therefore,the medical expenditure is predictable and controllable,and there will be a balanced environment between financing and expenditures for insurance fund.Meanwhile,under the fixed fee per service unit,it is convenient for Department of Medical insurance to integrate with compensatory pattern and to adjust their compensation package to keep balance between financing and expenditures.As a result,the most difficult problem of imbalance between financing and expenditure,from which Department of Medical insurance suffers,can be completely resolved.

关 键 词：总额预算 按服务单元付费 医保 收支平衡 

分 类 号：R197[医药卫生—卫生事业管理]