基于“病种点数法”结算的医保支付方式改革探索  

Exploration of the Reform of Medical Insurance Payment Method Based on “Sickness Method” Settlement

作　　者：袁红梅[1] 何克春[1,2] 杨燕 YUAN Hong-mei;HE Ke-chun;YANG Yan(Sanxia University People’s Hospital/The First People’s Hospital of Yichang,Yichang,Hube,443000,China)

机构地区：[1]三峡大学人民医院·宜昌市第一人民医院,湖北宜昌443000 [2]三峡大学卫生经济研究所,湖北宜昌443000

出　　处：《中国医院管理》2020年第6期89-91,共3页Chinese Hospital Management

基　　金：湖北省卫生健康委指定性项目(WJ2019D001)。

摘　　要：医保支付方式直接影响着医疗保险基金的支出、医疗机构的服务提供和参保人员的利益。宜昌市医保局秉持系统思维和创新理念,积极探索医保付费方式改革,在湖北省首推医保"病种点数法"结算方法,并不断建立健全和完善一系列配套机制。针对目前实施过程中的不足,提出应从医院、医保局、医务人员等3个方面改进的建议。Medicare payment methods directly affect the expenditure of medical insurance funds,the service provision of medical institutions and the interests of insured persons. Yichang Medical Insurance Bureau upholds the system thinking and innovative ideas,actively explores the reform of medical insurance payment methods,and firstly promotes the medical insurance"sickness method"settlement method in Hubei Province,and continuously establishes and perfects a series of supporting mechanisms. In response to the shortcomings in the current implementation process,suggestions for improvement from hospitals,medical insurance bureaus,and medical personnel are proposed.

关 键 词：医保支付方式 病种点数法 医院管理 

分 类 号：R197.1[医药卫生—卫生事业管理]