某市紧密型县域医共体医保支付模式优化研究  

Study on the optimization of medical insurance payment model in a city's compact county medical consumption linkage

作　　者：刘亚孔[1] 李晓燕 LIU Yakong;LI Xiaoyan(First Clinical Medical College of China Three Gorges University,Yichang,Hubei Province,443003,PRC)

机构地区：[1]三峡大学第一临床医学院,湖北省宜昌市443003 [2]国家卫生健康委干部培训中心(国家卫生健康委党校),北京市100024

出　　处：《中国医院》2023年第6期15-17,共3页Chinese Hospitals

摘　　要：目的:在对紧密型县域医共体医保问题分析的基础上提出支付模式优化建议。方法:2022年6~8月,对某市医共体医保支付情况进行实地调查,对存在的问题进行探讨。结果:某市紧密型县域医共体医保支付模式存在权责内容及支付依据偏差,其权责内容应从离散无序到整合有序,支付依据应从费用控制到质量考评。结论:优化紧密型县域医共体医保支付模式,能有效促进优质医疗资源下沉、提升基层医疗服务效能和推进分级诊疗。Objective:Based on the analysis of health insurance problems in compact county medical consumption linkage,we propose payment model optimization.Methods:From June to August 2022,a field survey of health insurance payments in a city medical consumption linkage was conducted to explore the problems.Results:There are deviations in the content of rights and responsibilities and payment basis in the medical insurance payment model of a compact county medical consumption linkage in a certain city.The content of rights and responsibilities should be from discrete and disorderly to integrated and orderly,and the basis of payment should be from cost control to quality assessment.Conclusion:Optimizing the medical insurance payment model of compact county medical consumption linkage can effectively promote the sinking of high-quality medical resources,enhance the effectiveness of grassroots medical services and promote the hierarchical medical system.

关 键 词：紧密型 县域医共体 医保支付 优化路径 

分 类 号：R197[医药卫生—卫生事业管理]