医疗服务价格改革与医保支付方式改革的政策协同  

Policy Coordination between Medical Service Price Reform and Medical Insurance Payment Reform

在线阅读下载全文

作  者:王震[1] Wang Zhen

机构地区:[1]中国社会科学院经济研究所

出  处:《社会政策研究》2025年第1期56-69,M0003,M0004,共16页Social Policy Research

摘  要:本文系统分析了医疗服务价格改革与医保支付方式改革之间的政策冲突及其协同路径。传统的分解式的医疗服务定价模式基于对单个项目的成本补偿,而医保的前瞻性打包支付则基于不同病组的比价关系以及医保支付总额。二者之间的冲突既体现为医保与医疗机构之间的矛盾,也反映在医保内部政策的不一致上。在医保成为主要战略购买方的背景下,应以医保支付方式改革协同医疗服务价格改革,实现由分解式定价向打包式定价转变。对于具备条件能够实行前瞻性打包付费的服务要改变按项目分解式定价的方式,统一进行打包付费,对于不具备条件实行打包支付的服务项目,其定价模式也要变为按照支付方式改革的模式进行定价。This paper systematically analyzes the policy conflicts and coordination pathways between medical service price reform and medical insurance payment reform.The traditional decomposed pricing model for medical services is based on cost compensation for individual items,while prospective bundled payments by medical insurance are based on the relative pricing of different disease groups and the total amount of medical insurance payments.The conflict between these two approaches is manifested not only as contradictions between medical insurance and medical institutions but also as inconsistencies within medical insurance policies themselves.Against the backdrop of medical insurance becoming the primary strategic purchaser,it is necessary to coordinate medical service price reform with medical insurance payment reform to achieve a shift from decomposed pricing to bundled pricing.For services that meet the conditions for prospective bundled payments,the decomposed pricing method should be changed to unified bundled payments.For service items that do not meet the conditions for bundled payments,their pricing models should also be adjusted to align with the payment reform approach.

关 键 词:医疗服务价格 医保支付方式 政策冲突 协同改革 

分 类 号:R197.1[医药卫生—卫生事业管理] F842.684[医药卫生—公共卫生与预防医学]

 

参考文献:

正在载入数据...

 

二级参考文献:

正在载入数据...

 

耦合文献:

正在载入数据...

 

引证文献:

正在载入数据...

 

二级引证文献:

正在载入数据...

 

同被引文献:

正在载入数据...

 

相关期刊文献:

正在载入数据...

相关的主题
相关的作者对象
相关的机构对象