上海市实施医保总额预付制的思考  

Thinking on the Global Budgeting in Hospitals in Shanghai

作　　者：阎元[1] 吕飞舟[2] 陈澍[3] 

机构地区：[1]复旦大学附属华山医院北院医保办公室,上海201907 [2]复旦大学附属华山医院北院院长室,上海201907 [3]复旦大学附属华山医院医保办公室,上海200040

出　　处：《医学与社会》2015年第2期49-51,共3页Medicine and Society

摘　　要：总额预付制的改革涉及医疗服务体系利益格局的调整。本文通过对上海市医保预付制的实施情况,总额预付制对医院的管理行为、服务行为和服务效能产生的积极作用以及其引发的总额难以精确测算和医疗服务不足的问题进行分析和思考,提出探索医疗联合体、多种付费形式相结合、增强医院核心竞争力、加强医院医保管理及合理引导参保人就医等相关对策和建议,从而进一步推动预付制改革。Reform of global budgeting adjusts the pattern of interests in the health system, lnrougn analysis an,a mmKmg oi me m^p~ementu- tion in Shanghai, the active effects of management behavior, service behavior and service performance in hospital as well as the new problems of the difficulty in accurately budgeting and inadequate medical care, propose the related countermeasures and suggestions such as building the medi- cal association, the combination of multiple payment forms, enhancing the core competitiveness and medical insurance management in hospital, reasonable guiding the insured to further promote the reform of global budgeting.

关 键 词：医疗保险 总额预付 

分 类 号：R197.1[医药卫生—卫生事业管理]