对银川市职工基本医疗保险总额预付的测算研究  

The Estimation and Research on the Total Prepayment of Employee Essential Medical Insurance in Yinchuan

作　　者：李林贵[1] 朱莉莉 龚福玲 钱磊[1] 杨丹琳[1] 时媛媛[1] 

机构地区：[1]宁夏医科大学,银川750004 [2]银川市医保中心,银川750004

出　　处：《中国卫生经济》2013年第12期33-35,共3页Chinese Health Economics

基　　金：国家自然科学基金(2012/71240024)

摘　　要：目的:为控制医疗费用,改变支付方式,探讨总额预算下不同的测算方法和医保方案的设计。方法:在对银川市职工基本医保2012年总额预算描述性分析的基础上,采用比较分析的方法。结果:3种测算中,方法三考虑了医院的综合考评、需求释放、物价增长指数和住院次均费用等系数,比较符合实际运行情况。文章同时还探讨了总额预算过程中如何按照主要收入病种和主要业务量病种进行结构控制。建议:科学合理测算总预算额和各医院分配额;在总额预算基础上必须配合合理的结构控制机制。Objective： To control medical insurance expenditure, reform the payment and explore different estimation methods and insurance scheme under total prepayment. Methods： Based on 2012 total prepayment descriptive analysis of essential medical insurance for employees in Yinehuan, comparative analysis is used. Results： Within three methods, the third method considered the hospital comprehensive performance, demanding release, price index and per capita expenditure, which is accord with actual operation situation. According to main income diseases and main business diseases, how to perform the structure control in the process of total prepayment was discussed. Suggestion： Total prepayment and hospital collocation should be estimated scientifically and reasonably, reasonable structural control mechanism should be considered based on total prepayment.

关 键 词：城镇职工基本医疗保险 总额预付 测算 银川 

分 类 号：F842.6[经济管理—保险]