实行医疗保险总额预付制改革的思考  

Thinking on the Implementation of Total Prepaid Medical Insurance Reform

作　　者：杨炯[1] 李劲松[1] 

机构地区：[1]上海交通大学医学院附属新华医院,上海200092

出　　处：《中国医院管理》2013年第3期65-67,共3页Chinese Hospital Management

摘　　要：总额预付制是由医保部门在对医疗机构进行评估后,计算出人均医疗费用,根据服务量和人均医疗费用,测算出医院的年度费用标准,按此费用标准向医院预付定额的医疗费。对上海医保总额预付制的模式、实施成效、存在的问题进行了思考和探讨,对总额预付的运用及改进提出了初步设想,以此推动医疗保险付费方式改革的持续开展。In a total prepaid system, medical insurance bureau makes evaluation of medical institutions and calculates per capita health care costs. Based on service volume and per capita health care costs, the bureau estimates annual cost standard for a hospital and prepays fixed medical expenses according to this standard. The paper made reflections and discussions on Total Prepaid Medical Insurance System in Shanghai in terms of its mode, effectiveness of imple- mentation and existing problems. Preliminary ideas were proposed on the application and improvement of total prepaid system, with an aim to promote the continuous progress of medical insurance payment reform.

关 键 词：医疗保险 总额预付制 改革 

分 类 号：R197.1[医药卫生—卫生事业管理]