我国机构医养结合服务的保险支付困境与体系优化  

The Insurance Payment System of Institutional Integrated Medical Care Service in China:Problems and Solutions

作　　者：方烨[1] Fang Ye(School of Economics and Management,Dongguan Polytechnic,Dongguan 523808,China)

机构地区：[1]东莞职业技术学院经济与管理学院,广东东莞523808

出　　处：《无锡商业职业技术学院学报》2022年第2期49-53,81,共6页Journal of Wuxi Vocational Institute of Commerce

基　　金：东莞职业技术学院重点科研课题“机构医养结合养老服务的社会保障对接困境及破解”(2020a01)。

摘　　要：为缓解制约我国机构医养结合服务发展的医疗保险和长期护理保险支付问题,并进一步促进我国机构医养结合服务的可持续发展,通过梳理典型国家利用保险体系承担机构医养结合服务费用的经验做法,探索我国机构医养结合服务保险支付体系的优化路径。建议我国打通机构医疗服务的基本医疗保险支付壁垒,拓宽保障覆盖面;发展与机构医养结合服务相融合、与基本医疗保险制度相衔接的商业健康保险;建立支持机构护理的长期护理保险制度,开发与之相衔接的商业长期护理保险;不断完善机构医养结合服务保险支付的法律制度。To solve the payment problems of medical insurance and long-term care insurance that restricts the development of institutional integrated medical care service in China,and further promote the sustainable development of institutional integrated medical care service,this article combs the experience and practice of institutional integrated medical care service payment through medical insurance system in typical countries,which can provide reference for improving the payment system of institutional integrated medical care service in China.It is suggested that China should remove the payment barriers of basic medical insurance for institutional medical service and broaden the coverage of medical insurance,develop commercial health insurance integrated with institutional medical care service and the basic medical insurance system,establish a long-term care insurance system to support institutional nursing and develop commercial long-term care insurance connected with it,and improve the legal system of insurance payments for institutional integrated medical care service.

关 键 词：机构医养结合服务 保险支付体系 医疗保险 长期护理保险 

分 类 号：R197.1[医药卫生—卫生事业管理]