我国台湾地区按人头总额预付改革实践及启示  

Discussion on the reform of global per capita budget in Taiwan,China

作　　者：吴文琪 曾理 钟正东 黄雨萌 项莉[1] Wu Wenqi;Zeng Li;Zhong Zhengdong;Huang Yumeng;Xiang Li(School of Medicine and Health Management,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院医药卫生管理学院,武汉430030

出　　处：《中华医院管理杂志》2020年第12期974-978,共5页Chinese Journal of Hospital Administration

基　　金：国家自然科学基金(71874058)。

摘　　要：作者介绍了我国台湾地区按人头总额预付改革的措施,对区域整合模式、医院忠诚患者模式、社区医疗群模式3种改革模式的策略侧重点和成效进行详细阐述。结合我国大陆地区医疗服务体系和医疗联合体建设现状分析,认为紧密型医疗联合体是最理想的发展方向,建议医保部门通过风险校正提升总额设定的科学性,可采取垫付机制、基本公共卫生服务经费捆绑医保资金支付等方式鼓励医疗联合体转变服务模式。This paper introduced the payment reform of global per capita budget in the Taiwan region,and analyzed the service strategies and effects of three different models:regional integration model,hospital loyal patient model,and community medical group model.Based on the analysis of the current situation of medical service system and medical alliances construction in China's Mainland,the close medical alliance should be the most ideal development direction.It is suggested that the medical insurance department should improve the reasonability of the global budget through risk correction,and encourage the medical alliances to change the service mode by adopting the advance payment mechanism and combining basic public health services funding with medical insurance funds,etc.

关 键 词：按人收费 总额预付 支付方式改革 医疗联合体 案例分析 

分 类 号：R197.1[医药卫生—卫生事业管理]