[1]李 芬,陆士辰,顾淑玮,等.我国医共体医保制度改革进展及其影响分析[J].卫生经济研究,2020,(08):30-33.
　LI Fen,LU Shi-chen,GU Shu-wei,et al.Analysis on the Progress and Its Influence of the Medical Insurance System Reform of Medical Alliance in China[J].Journal Press of Health Economics Research,2020,(08):30-33.
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我国医共体医保制度改革进展及其影响分析
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卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
期数:
2020年08期
页码:
30-33
栏目:
聚焦医改
出版日期:
2020-07-31

文章信息/Info

Title:
Analysis on the Progress and Its Influence of the Medical Insurance System Reform of Medical Alliance in China
作者:
李 芬1; 陆士辰1; 顾淑玮2; 金春林1; 宁玉玲3
1.上海市卫生和健康发展研究中心（上海市医学科学技术情报研究所），上海 200040
2.苏州大学附属第二医院科研处，江苏 苏州 215000
3.上海市医药集中招标采购事物管理所，上海 200023
Author(s):
LI Fen; LU Shi-chen; GU Shu-wei; JIN Chun-lin; NING Yu-Ling
Shanghai Health Development Research Center(Shanghai Medical Information Center),Shanghai 200040,China
关键词:
医共体; 医保制度改革; 总额预付; 捆绑支付
Keywords:
medical alliance; medical insurance system reform; global budget; bundling payment
分类号:
R197
文献标志码:
A
摘要:
医保制度改革是医共体整合的核心，包括总额测算方式、医保资金分配、医保支付方式和支付标准、资金结余分配及超支分担、配套考核等，都会对医共体利益相关者（政府部门、医疗机构、医务人员和患者等）产生影响。当前医共体医保制度改革的难点和重点在于进一步完善总额测算方法、探索疾病全程管理的捆绑支付、建立多层面的配套考核机制等。
Abstract:
The medical insurance system reform is the core of the medical alliance's integration,including global budget method,medical insurance fund allocation,medical insurance payment method and payment standard,fund balance allocation and over-expenditure sharing,supporting evaluation and so on,and these factors will have influence on the stakeholders of the medical alliance(government departments, medical institutions,medical staffs,patients and so on).At present,the difficulty and focus of the medical insurance system reform of medical alliance is to further improve the global budget method,explore the bundled payment of the whole processing management of diseases, and establish a multi-level supporting evaluation mechanism.

参考文献/References:

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[6] 杨振然，谭华伟，张培林，等.我国区域纵向医疗联合体医保支付改革：实践模式与政策路径[J].中国卫生资源，2018（2）：127-132.
[7] Struijs, JNand CA Baan, Integrating care through bundled payments——lessons from The Netherlands[J]. N Engl J Med, 2011,364(11): 990-991.
[8] Commonwealth of Massachusetts，Special Commission on the Health Care Payment System. Recommendations of the special commission on the health care payment system[EB/OL].(2009-07-16)[2015-12-12]. http://www.mass.gov/eohh.

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更新日期/Last Update: 2020-07-31