医疗保险总额预付试点经验分析和思考  

Analysis and Thought of the Experiences of Medical Global Budget in Pilot Areas

作　　者：张敏[1] 叶露[1] 

机构地区：[1]复旦大学公共卫生学院公共卫生安全教育部重点实验室,上海200032

出　　处：《中国卫生经济》2014年第10期45-47,共3页Chinese Health Economics

摘　　要：目的:总结各地总额预付方式的试点经验,探讨分析各个利益群体在总额预付制背景下如何平衡其关系。方法:根据文献分析各地区总额预付试点的现状,发现存在的缺陷和总结成功经验。结果和结论:在医疗联合体内,才能进一步科学计算出总额预付额度;建立科学民主的协商谈判机制;根据医保基金的使用率情况,建立有效的奖罚结合机制;加强医疗服务质量管理。Objective： To summarize the experience of global budget in different pilot areas, and explore how to keep balance the relationships of different stakeholders under the background of global budget. Methods： The status quo of the global budget in areas was analyzed based on literature, the defects were discovered and successful experiences were summarized. Results ＆ Conclusion： The exact total budget for health care could be estimated in a joint body. It is needed to establish a scientific and democratic negotia- tion mechanism; establish an effective mechanism of reward and punishment according to the usage of medical insurance fund; strengthen the management of the medical service quality.

关 键 词：医疗保险 总额预付 预付额度 谈判机制 

分 类 号：F842.6[经济管理—保险]