关于建立基于价值“按效果付费”机制的思考  

Reflections on Establishing a Value Based "Pay-for-Effect" Mechanism

作　　者：范国富 范馨 Fan Guofu;Fan Xin(Zhenjiang Municipal Human Resources And Social Security Bureau,Zhenjiang,212000)

机构地区：[1]镇江市人力资源和社会保障局,镇江212000

出　　处：《中国医疗保险》2018年第12期33-37,共5页China Health Insurance

摘　　要：医保作为向医疗机构购买服务的第三方,同时承担着筹资者和购买者的双重角色。除了确保医保基金使用效率,保障参保人员的基本医疗需求外,还要具备通过支付杠杆,激励约束医疗行为以及控制医疗费用增长的功能。本文试图在医保支付管理体系中引入"按效果付费"理念,通过梳理"按效果付费"内涵及其对于医保付费的应用价值,探讨其在医保基金支付管理中的实现路径,分析在医保付费管理中可能面临的困难,为"按效果付费"理念在医保支付管理中的运用提供理论依据。Medical insurance, as a third party to purchase services from medical institutions, plays a dual role of fundraiser and purchaser. In addition to ensuring the efficiency of the medical insurance fund and the basic medical needs of the insured, it also has the functions of stimulating and restraining medical behavior and controlling the growth of medical expenses through payment leverage. This paper attempts to introduce the concept of ＂pay- for-effect＂ mechanism into the medical insurance payment management system. By sorting out its connotation and the application value of medical insurance payment, it explores its realization path in the medical insurance fund payment management. This paper also analyses the difficulties that may be faced in the management of medical insurance payment, and provides a theoretical basis for the application of the concept of ＂pay-for-effect＂ mechanism in the management of medical insurance payment.

关 键 词：按效果付费 应用价值 路径 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]