医保支付方式改革协商谈判与争议处理的框架研究——以厦门市为例  

Research on the Framework of Negotiation and Dispute Resolution for the Reform of Medical Insurance Payment Methods--Taking Xiamen City as an Example

作　　者：林茂伟 余丹[2] 

机构地区：[1]厦门市医疗保障数据监测中心,厦门361004 [2]厦门大学医学院,厦门361004

出　　处：《中国医疗保险》2023年第11期98-102,共5页China Health Insurance

摘　　要：医疗保险管理机构与医疗机构之间协商谈判与争议处理机制是完善医保支付方式改革的关键环节。本文通过福建省厦门市DIP付费中协商谈判与争议处理的具体实例,探讨支付方式改革过程中协商谈判与争议处理的政策依据、原则、目标、内容及实施流程,并提出完善协商谈判机制的建议,以期进一步深化医保支付方式改革。Negotiation and dispute resolution mechanism between medical insurance management institutions and medical institutions is the key link to improve the medical insurance payment method reform.This paper discusses the policy basis,principle,objective,content and flow of negotiation and dispute resolution in the process of payment reform with specific examples of negotiation and dispute resolution in Xiamen DIP payment,and puts forward suggestions to improve the negotiation mechanism and deepen the reform of medical insurance payment methods.

关 键 词：协商谈判 争议处理 医保支付方式 核心要素调整 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]