医院实行医保总额预付制管理的思考  

Thoughts on the Management of Total Medical Insurance Prepaid System in Hospitals

作　　者：吴丽琴[1] 徐志良[1] WU Li-qin;XU Zhi-liang(Wujin Hospital of TCM,Changzhou,Jiangsu,213161,China)

机构地区：[1]常州市武进中医医院

出　　处：《中国医院管理》2019年第12期63-64,共2页Chinese Hospital Management

摘　　要：总额预付制是根据医保筹资结合医院实际运行情况,由医保部门对医院评估后,根据服务量和人均医疗费用,测算出医院的年度费用标准,并按该标准向医院预付医药费总额。对实行总额预付以后的优缺点进行了分析,指出存在的问题。对总额预付的运用及改进提出了设想,以期推动付费方式改革的良性发展。Based on the medical insurance financing combined with the actual operation of the hospital,by the Medical Insurance Department to the hospital evaluation,and according to the amount of service and per capita medical expenses,the total prepayment system is used to calculate the hospital’s annual cost standard,and according to the standard prepaid medical expenses to the hospital. The paper analyzes the advantages and disadvantages of the total amount of prepayment,and points out the existing problems. The paper puts forward some ideas on the application and improvement of total prepayment,in order to promote the benign development of payment mode reform.

关 键 词：医疗保险 总额预付制 改革 

分 类 号：R197.1[医药卫生—卫生事业管理]