[1]阮博宇,边云凤,马宇豪,等.紧密型县域医共体 医保总额预算典型模式及优化路径[J].卫生经济研究,2025,42(06):63-67,72.
　RUAN Boyu,BIAN Yunfeng,MA Yuhao,et al.Study on Typical Model of and Optimization Path of Total Budget in Medical Insurance in Compact County-level Medical Community[J].Journal Press of Health Economics Research,2025,42(06):63-67,72.
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紧密型县域医共体 医保总额预算典型模式及优化路径

卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
42
期数:
2025年06期
页码:
63-67,72
栏目:
医疗保障
出版日期:
2025-05-29

文章信息/Info

Title:
Study on Typical Model of and Optimization Path of Total Budget in Medical Insurance in Compact County-level Medical Community
作者:
阮博宇1; 边云凤1; 马宇豪1; 苏 岱1
1.首都医科大学公共卫生学院，北京 100069
Author(s):
RUAN Boyu;  BIAN Yunfeng;  MA Yuhao;  SU Dai
School of Public Health, Capital Medical University, Beijing 100069, China
关键词:
医保总额预算; 整合型服务体系; 医保总额付费; 紧密型县域医共体
Keywords:
total budget in medical insurance;  integrated service system;  total payment in medical insurance;  compact county-level medical community
分类号:
R19；F840.684
文献标志码:
A
摘要:
当前，我国各地开展紧密型县域医共体医保总额付费改革，形成了差别化的总额预算和预付模式，在实施范围、打包范围、支付总额、基金拨付和结算等多个维度呈现出不同的特点，但也存在尚待完善的问题。美国、荷兰、加拿大等国家致力于通过科学合理的医保总额预算制度，保障国民的基本医疗需求，提高医疗服务的可及性和质量，其典型经验对我国有一定的借鉴意义。基于此，我国应加强医保总额预算的政策协同和标准统一，结合地区特点和系统因素科学测算付费总额，并促进县域医共体之间支付机制的有效衔接，有效设置激励机制，确保医保基金的合理使用和县域医共体的可持续发展。
Abstract:
At present, the reform of total payment in medical insurance in compact county-level medical communities is carried out all over the country in China, which is forming a differentiated total budget and prepayment model. It presents different characteristics in many dimensions such as implementation scope, packaging range, total payment, fund allocation and settlement, but there are also some problems that have yet to be perfected. The United States, the Netherlands, Canada and other countries are committed to ensuring the basic medical needs of their citizens and improving the accessibility and quality of medical services through a scientific and reasonable total budget system in medical insurance, and their typical experiences have certain reference significance to our country. Based on this, China should strengthen the policy synergy and standardization of the total budget in medical insurance, scientifically measure the total amount of payment by combining the regional characteristics and systematic factors, and promote the effective connection of the payment mechanism among the county-level medical communities, and effectively set up the incentive mechanism, so as to ensure the rational use of the medical insurance fund and the sustainable development of the county-level medical communities.

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更新日期/Last Update: 2025-05-29