新型农村合作医疗三种管理模式适宜支付方式选择研究  

Study on Choosing the Suitable Payment Methods of Three Management Modes of New Rural Cooperative Medical System

作　　者：苏晓培[1] 王小合[1] 顾亚明[2] 张双竹 钱宇[1] 张萌[1] 

机构地区：[1]杭州师范大学健康管理学院,杭州310036 [2]浙江省卫生厅基层卫生管理处,杭州310006

出　　处：《中国卫生经济》2013年第5期65-68,共4页Chinese Health Economics

基　　金：教育部人文社科研究青年基金项目(09YJC630054);浙江省医药卫生科技计划项目(2011KYA125);杭州师范大学研究生创新基金资助项目(2012-19)

摘　　要：由于新农合不同管理模式所涉及的主要利益相关者及战略利益诉求不同,其支付方式必然有适宜性选择。以利益相关者理论为基础,经对常见五种医保支付方式及新农合3种管理模式涉及的主要利益相关者与利益诉求比较分析,从国家战略诉求及多方均衡利益最大化的视角,研究提出卫生部门主管并经办模式,门诊应选择按人头付费方式,住院按病种付费+服务单元付费组合方式;劳保部门主管并经办模式,门诊应选择总额预付制方式,住院按总额预付制+病种付费组合方式;政府委托商业保险机构经办模式,门诊应选择总额预付制+服务单元付费,住院按总额预付制+服务单元付费的组合方式。It analyzes the key takeholders and strategic interest demand conflict so that the payment needs to be chosen properly. Besed on the stakeholder theory, the key takeholders and strategic interest demand of five common medical insurance payments and the three main management modes of the new rural cooperative medical system are compared. From the implementation of national strategy and maximum of various balance interests perspective, the health department supervisor mode should adopt outpatient service capitation and the combined inpatient service payment of DRGs and services unit fee. The labor and social security department supervisor mode should adopt the global budget for outpatient service and the combined inpatient service payment of global budget and DRG inpatient service. And the commercial insurance company supervisor mode should adopt global budge and and services unit fee for outpatient service and the combined inpatient service payment of global budge and services unit fee.

关 键 词：新型农村合作医疗 管理模式 支付方式 战略利益诉求 利益相关者 

分 类 号：R197.1[医药卫生—卫生事业管理]