我国典型医联体模式下医保支付方式实施效果研究  

Study on the Effect of Medical Insurance Payment Method Under Medical Alliance Mode of China

作　　者：张嘉文 李霞 张梦然 唐文熙[1] ZHANG Jia-wen;LI Xia;ZHANG Meng-ran(School of International Pharmaceutical Business,China Pharmaceutical University,Nanjing,Jiangsu,211198,China)

机构地区：[1]中国药科大学国际医药商学院

出　　处：《中国医院管理》2020年第2期15-17,29,共4页Chinese Hospital Management

基　　金：国家自然科学基金青年科学基金项目(71603278);中国药科大学青年教改专项(2017XJQN32);大学生创新创业训练计划项目(201910316179)

摘　　要：目的梳理医联体医保支付在不同地区的实施情况,归纳支付方式及实施效果,提出存在问题及相应建议。方法采用文献计量分析,根据综述流程,对纳入的文献进行特征分析,归纳我国典型医联体模式下医保支付方式和效果。结果医院控费积极性增高,次均诊疗费用下降;分级诊疗得以推进;患者就医比例增加,自付医疗费用下降,实际报销比例增长。结论我国探索医联体模式下医保支付方式已取得一定成效,但还需进一步探索适合医联体的混合支付方式,重视对医疗工作者的激励,健全医疗质量的考核机制和监督体系。Objective To sort out the implementation of medical insurance payment in different areas of China,summarize ways of payment,effects of implementation,existing problems,and make recommendations.Methods Using bibliometric analysis to analyze the characteristics of the included literatures according to the systematic review process.Results This kind of payment method increased the hospital’s self-control fee awareness,and decreased the average cost of diagnosis and treatment;the hierarchical medical system was promoted;the proportion of patients seeking medical treatment and the actual reimbursement rate increased,and the patient’s out-ofpocket expenses decreased.Conclusion In China,the payment method under the medical alliance mode has received certain success,but it is necessary to further explore the mixed payment method which is suitable for medical alliance,attach importance to the incentives for medical personnel,and improve the evaluation mechanism and supervision system of medical service quality.

关 键 词：医联体 医保支付方式 总额预付制 

分 类 号：R197.1[医药卫生—卫生事业管理]