基本医疗保险部门在慢性病管理中的作用探讨  

Discussion on the Role of Basic Medical Insurance Department in the Management of Chronic Diseases

作　　者：李运华[1] 雷腾 LI Yunhua;LEI Teng

机构地区：[1]武汉大学社会保障研究中心,湖北武汉430072

出　　处：《决策与信息》2021年第2期31-38,共8页Decision & Information

摘　　要：慢性病管理包括疾病的准入、干预、治疗、评估等环节,需要多部门之间的配合。当前我国慢性病管理主要由卫生行政部门主导,医疗机构提供服务项目,但因为发展存在不足,导致慢性病管理陷入困境。突出表现在卫生行政部门未能主导建立完善的慢性病管理体系、医疗卫生机构无法提供完善的服务项目。针对慢性病管理中卫生系统内部变革动力不足的问题,可以使第三方付费者,即基本医疗保险部门积极主动地参与到慢性病管理的环节中,发挥医保基金经济杠杆作用,在一定程度上解决慢性病管理中卫生行政部门与医疗卫生部门存在的问题。在此基础上,从病种准入、支付方式、考核评估、信息化建设等管理环节来强化基本医疗保险部门作用的发挥,促进慢性病管理的日臻完善。The management of chronic disease management includes the admission,intervention,treatment and evaluation of diseases,which requires cooperation among various departments.At present,China's chronic disease management attaches great importance to the cooperation between health administrative departments and medical institutions,which are mainly led by health administrative departments,and medical institutions provide services.However,due to the lack of development,chronic disease management is in trouble.Outstanding performance is that medical and health institutions can not provide perfect service items,health administrative departments can not establish an effective evaluation mechanism,and have not formed a perfect chronic disease management system.In view of the lack of motivation for reform in the health system,the basic medical insurance department can actively participate in the management of chronic diseases,and play the role of economic leverage between third-party payers and medical insurance funds,so as to solve the two prominent problems in the management of chronic diseases to a certain extent,and alleviate the difficulties faced by the current management of chronic diseases.On this basis,the role played by the basic medical insurance department is discussed from the aspects of disease access,payment methods,and assessment and information construction,so as to promote the sustainable development of chronic disease management.

关 键 词：慢性病管理 医疗保险 基本医疗保险 作用机制 

分 类 号：C913.7[经济管理]