基于效果与质量的医保费用支付方式设计  

Effect and quality-based medical insurance payment mode

作　　者：刘同柱[1,2] 

机构地区：[1]合肥工业大学管理学院,安徽合肥230009 [2]安徽省立医院,安徽合肥230001

出　　处：《中国农村卫生事业管理》2017年第11期1289-1292,共4页Chinese Rural Health Service Administration

基　　金：国家自然科学基金面上项目(71173003)

摘　　要：文章从当前我国医保费用支付方式存在的问题入手,在综合运用临床审计、临床路径和质效补偿等领域理论的基础上,提出了基于效果与质量的医保费用支付方式。期望通过从诊疗服务效果与质量方面以及诊疗服务与医保监管方面提出有针对性的具体措施,实现诊疗服务效果和质量标准化、医保费用审核和监督科学化,以及医保费用支付范围和流向合理化等目标。Facing the problems in the current medical insurance payment modes in China,we put forward an effect and quality-based medical insurance payment mode on the basis of several theories in clinical audit,clinical pathway and payment for performance.We introduced specific measures regarding the effect and quality of medical services and the supervision of medical services and medical insurance,so as to realize the standardization of effect and quality of medical services,the scientific audit and supervision of medical insurance costs,and the rationalization of medical insurance payment scopes and flows as well.

关 键 词：医保 支付方式 效果 质量 

分 类 号：F842.684[经济管理—保险] R197.1[医药卫生—卫生事业管理]