天津市公立医院总额预付下医保支付现状研究  

Studying on the status of medical insurance payment in total prepaid system in state-owned hospitals of Tianjin

作　　者：杨圣贤[1] 徐霁[2] 侯庆春[2] 骆达[2] 马明慧[2] 邹琳[2] 康艳[2] 杨文秀[2] 

机构地区：[1]天津医科大学公共卫生学院,天津300070 [2]天津市医学科学技术信息研究所

出　　处：《中国卫生事业管理》2013年第1期32-34,共3页Chinese Health Service Management

基　　金：2012年天津市政府决策咨询重点课题项目(编号:ZF2X2012-43)

摘　　要：目的:通过对2006～2010年天津市7家三级甲等医院医疗保险支付情况和经济运行情况的调研和系统分析,了解天津市大型公立医院医疗保险支付方式的现状,为有关部门制定相关卫生政策提供参考。方法:从医院的医保运行情况和经济运行情况两个方面分析5年来天津市大型公立医院总额预付制度运行的相关情况。结果:天津市近年来医保覆盖率不断攀升,医院医保就诊人次逐年大幅增加,然而每年总额预付额度上涨幅度不明显,总额预付额度核算方式欠科学,医保基金拒付情况严重。结论:在更好满足我市医保患者就诊质量的同时,需进一步完善总额预付核算方式,加强医保管理部门和公立医院之间的协同合作与真诚沟通,有效降低医保患者个人支付比例,减少医院的经济负担。Objective To study the status of medical insurance payment and operation in seven eases of grade three and first- class hospitals in Tianjin,and provide references for the government to formulate health policies. Methods The status of medical insurance payment in total prepaid system in state-owned hospitals of Tianjin in 5 years was analyzed from two aspects of medical insurance payment and economics operation. Results The coverage of medical insurance and person-time of patients kept rising in recent years in Tianjin. But the range of increasing total prepaid was insignificant. And its accounting method was not reasonable. Conclusion In addition to improve medical service quality, countermeasures should be put forward to further improve the total pre- paid accounting mode, strengthen cooperation between hospitals and management department, decrease the proportion of payment from individuals ,and reduce economic burden on hospitals.

关 键 词：医保支付方式 总额预付制度 公立医院 拒付 

分 类 号：R197.3[医药卫生—卫生事业管理]