[1]姚 辉,谭华伟,郭丹丹,等.市级统筹下紧密型县域医共体总额付费的 政策框架与优化路径[J].卫生经济研究,2026,43(06):53-56.
　YAO Hui,TAN Huawei,GUO Dandan,et al.Policy Framework and Optimization Pathways for Global Payment of County-Level Integrated Health Organizations Under Prefectural-Level Risk Pooling[J].Journal Press of Health Economics Research,2026,43(06):53-56.
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市级统筹下紧密型县域医共体总额付费的 政策框架与优化路径

卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
43
期数:
2026年06期
页码:
53-56
栏目:
健康服务体系
出版日期:
2026-06-03

文章信息/Info

Title:
Policy Framework and Optimization Pathways for Global Payment of County-Level Integrated Health Organizations Under Prefectural-Level Risk Pooling
作者:
姚 辉1; 谭华伟2; 郭丹丹3; 张雪雨2; 彭馨怡2; 陈迎春2
1.霍邱县人民医院，安徽 六安 237400
2.华中科技大学同济医学院医药卫生管理学院，湖北 武汉 430030
3.湖北医药学院，湖北 十堰 442000
Author(s):
YAO Hui;  TAN Huawei;  GUO Dandan;  ZHANG Xueyu;  PENG Xinyi;  CHEN Yingchun
Huoqiu County People's Hospital, Lu'an Anhui 237400, China
关键词:
市级统筹; 紧密型县域医共体; 总额付费; 政策框架
Keywords:
prefectural-level risk pooling;  county-level integrated health organizations;  global payment;  policy framework
分类号:
R19
文献标志码:
A
摘要:
随着医保统筹层次由县级向市级提升，紧密型县域医共体总额付费的权责配置、主体和客体均发生了显著变化。医共体总额付费的预算、结算、清算、绩效管理需与市级统筹下的医保基金进行有效衔接。对此，搭建“前提条件、支撑条件、核心要素”三维分析框架，对50个市级医保统筹区的医共体总额付费政策进行总结分析，研究显示，未来政策应着力于明晰市级统筹与医共体总额付费的协同关系，强化医共体组织化建设，优化与DRG/DIP付费的衔接机制，并精准运用结算、监管与赋能工具，提升医共体的整体服务效能。
Abstract:
With the elevation of the overall medical insurance pooling level from the county to the municipal level, significant changes have taken place in the power and responsibility allocation, as well as the subjects and objects involved in the global budget payment of compact county-level medical communities. The budgeting, settlement, liquidation and performance management of global budget payment for medical communities need to be effectively aligned with medical insurance funds under municipal-level pooling. In response to this issue, this study constructed a three-dimensional analytical framework consisting of prerequisite conditions, supporting conditions and core elements to summarize and analyze the global budget payment policies for medical communities across 50 municipal medical insurance pooling areas. The research findings indicated that future policy formulation should focus on clarifying the collaborative relationship between municipal medical insurance pooling and the global budget payment of medical communities, strengthening the organizational development of medical communities, optimizing the docking mechanism with DRG and DIP payment reforms, and rationally applying settlement, supervision and empowerment tools, so as to improve the overall service efficiency of county-level medical communities.

参考文献/References:

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更新日期/Last Update: 2026-06-03