我国医保支付方式改革中的经验及思考  

Experience and reflections on healthcare insurance payment reform in China

作　　者：江丰 罗丽珊 李晓苑 陈博 张露文 张玫 JIANG Feng;LUO Lishan;LI Xiaoyuan;CHEN Bo;ZHANG Luwen;ZHANG Mei(Personnel Affairs Section,the Affiliated Traditional Chinese Medicine Hospital,Guangzhou Medical University,Guangzhou 510130,China;Hospital Infection Management Office,the Affiliated Traditional Chinese Medicine Hospital,Guangzhou Medical University,Guangzhou 510130,China;School of Health Management,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]广州医科大学附属中医医院人事科,广东广州510130 [2]广州医科大学附属中医医院医院感染管理办公室,广东广州510130 [3]南方医科大学卫生管理学院,广东广州510515

出　　处：《广州医药》2025年第4期559-565,共7页Guangzhou Medical Journal

摘　　要：目的为构建更加健全和可靠的医保体系,制定有效、公平和可持续的医保支付方式提出建议。方法对医保支付方式及各地医保支付方式改革的实践进行综合比较,总结改革的效果和经验。结果通过引入绩效导向的支付机制、推动综合付费方式、细化按疾病阶段付费、结合互联网医疗、强化数据能力、健全监管等方面推进医保支付方式改革。结论医保支付方式是规范医疗机构和医生医疗服务的重要手段,结合浙江省、广东省广州市等省市积极探索疾病诊断相关分组、按病种分值付费等医保支付方式,改革需要综合考虑医疗体制、经济发展水平、人口结构等各方利益和多个因素,通过综合实施,构建更加有效、公平和可持续的医保支付方式。Objective Provide suggestions for building a more sound and reliable medical insurance system,anddeveloping effective,fair and sustainable medical insurance payment methods.Methods The payment methods of medicalinsurance and the practice of medical insurance payment reform in various regions were comprehensively compared the effectivenessand experience of the reform were summarized.Results The reform of medical insurance payment mode was promoted by introducingperformance-oriented payment mechanism,promoting comprehensive payment mode,refining payment by disease stage,combiningInternet medicine,strengthening data capability,improving supervision,etc.Conclusions The payment method of medicalinsurance is an important means to standardize the medical services of medical institutions and doctors.In combination with the activeexploration of Diagnosis Related Groups,Diagnosis Intervention Packet and other medical insurance payment methods in provincesand cities such as Zhejiang and Guangzhou Guangdong.The reform needs to comprehensively consider the interests and multiplefactors of the medical system,economic development level,population structure,etc.To build a more effective,fair,andsustainable medical insurance payment method through comprehensive implementation.

关 键 词：医保支付方式 改革 经验 建议 

分 类 号：R197.1[医药卫生—卫生事业管理]