总额预付制下医保基金分配的问题及对策  

Problems and Countermeasures of Medical Insurance Fund Allocation Under Global Budget System

作　　者：卢芸芝 陶红兵[1] 黄亦恬 王亚楠 刘毅俊 张涛 LU Yun-zhi;TAO Hong-bing;HUANG Yi-tian;WANG Ya-nan;LIU Yi-jun;ZHANG Tao(School of Medicine and Health Management,Tongji Medical College,Huazhong University of Science and Technology,Wuhan Hubei 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,湖北武汉430030 [2]武汉市深化医药卫生体制改革工作领导小组办公室,湖北武汉430014

出　　处：《卫生经济研究》2021年第4期25-27,共3页

基　　金：国家自然科学基金资助项目(71774061)。

摘　　要：医保基金分配是总额预付制的核心,包括预算和结算两个关键环节。当前,我国总额预付制的医保基金分配存在一些局限性:总额确定思路与实际所需脱节、测算方法不够科学、分配方式不够合理、监督考核不够透明。对此,应科学测算与调整总额指标,统筹协商额度分配,规范费用结算与支付,探索基于总额预付的医保支付方式改革。The allocation of medical insurance fund is the core of global budget,including two key links of budget and settlement.At present,there are some limitations in the allocation of medical insurance funds based on global budget in China:the idea of determining the total amount is not meet actual needs,the calculation method is not scientific,the way of distribution is not reasonable,and the supervision and assessment is not transparent enough.In this regard,we should scientifically calculate and adjust the total amount index,overall negotiate the quota allocation,standardize the settlement and payment of expenses,and explore the reform of medical insurance payment mode based on global budget.

关 键 词：总额预付 医保付费 基金分配 

分 类 号：R197.1[医药卫生—卫生事业管理]