国内外医保总额预算制度比较研究  

Comparative Study on the Global Budget System of Medical Insurance at Home and Abroad

作　　者：陈娅锋 孙强 阴佳 CHEN Ya-feng;SUN Qiang;YIN Jia(不详;Center for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine,Shandong University,NHC Key Lab of Health Economics and Policy Research(Shandong University),Jinan Shandong 250012,China)

机构地区：[1]山东大学齐鲁医学院公共卫生学院,国家卫生健康委员会卫生经济与政策研究重点实验室(山东大学),山东济南250012

出　　处：《卫生经济研究》2022年第5期75-77,81,共4页

摘　　要：目的:总结比较国内外医保总额预算制度差异,为完善我国医保总额预算制度提供参考。方法:根据刊发的文献及出台的政策,梳理国内外总额预算制度,通过比较国内外预算总额的确定及分配、监管情况,分析我国医保总额预算制度存在的问题。结果:我国医保总额预算与实际所需存在偏差,总额控制未实现全面覆盖,总额确定及分配过程具有主观性、方法也有局限性,监督考核机制不完善。结论:建议建立以需求为导向、全面覆盖的医保总额预算制度,科学测算及分配预算总额,并完善相关配套措施。Objective To summarize and compare the differences between the global budget system of medical insurance fund at home and abroad,and to provide reference for improving the global budget system of medical insurance fund in China.Methods According to the literature and policies,the global budget system at home and abroad was sorted out,and the problems existing in the global budget system of medical insurance funds in China were analyzed by comparing the determination and distribution of global budget at home and abroad and the supervision of global budget.Results There are some problems in the global budget system of medical insurance in China,such as the deviation between the global budget and the actual demand,the total amount control not fully covering,the subjectivity of the total amount determination and allocation process,the drawbacks of the total amount determination and allocation method,and the imperfect supervision and assessment mechanism.Conclusion In order to improve the global budget system in China,it is suggested to establish a demand-oriented and comprehensive global budget system,scientifically measure and allocate the global budget,and the global budget system should be"parallel"with relevant supporting measures.

关 键 词：医疗保险 总额预算 总额确定 基金分配 监管 

分 类 号：F840.684[经济管理—保险]