医保支持家庭医生签约服务的模式探析  

Discussion on Mode of Basic Medical Insurance Schemes Supporting Family Doctors' Contracted Services

作　　者：宋大平 赵东辉 任静 付晓光 程念 SONG Da-ping;ZHAO Dong-hui;REN Jing

机构地区：[1]国家卫生计生委卫生发展研究中心,北京100191

出　　处：《中国卫生经济》2018年第12期67-70,共4页Chinese Health Economics

摘　　要：目的:总结提炼现阶段医保支持家庭医生签约服务的典型模式,为规范该项工作提供科学依据。方法:政策回顾、面上调查、典型调查。结果:现阶段主要存在6种医保支持家庭医生签约服务的典型模式,分别是支持签约服务费、医保打包付费、签约对象报销优惠、不签约不报销、医联体和医共体医保结余用于签约服务人员奖励、将转诊后大型医疗检查等费用额度交给签约团队所在首诊基层机构。结论:医保对于家庭医生签约服务的支持已形成一些模式,但总体上尚缺乏体制机制性设计,下一步有待以医保打包付费为主要支持模式,建立实体性和程序性机制,并完善配套措施。Objective: To sum up typical models of basic medical insurance schemes supporting family doctors’ contracted services in current stage, so as to provide scientific grounds to regulate the work. Methods: Policy review, overall investigation and typical investigation. Results: There were mainly 6 typical modes of basic medical insurance schemes supporting family doctors’ contracted services, including supporting the fee for family doctors’ contracted services, paying in a package, preferential policies for contracted enrollees, no reimbursement if not contracted, surplus from basic medical insurance schemes used on the contracted team in medical consortiums, and handling over post-referral amounts of major medical examinations to primary health facilities sending out contracted teams. Conclusion: There were a few models of basic medical insurance schemes supporting family doctors’ contracted services, however, effective and systematic mechanisms were still in shortage. Substantial and procedural mechanisms should be established and matching measures should be improved after the main supporting model chosen as paying in a package.

关 键 词：家庭医生签约服务 医疗保障资金 医疗保障机制 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] R197.62