[1]吴海波,刘统银,朱文芝.基本医疗保险控费模式比较研究[J].卫生经济研究,2019,(10):36-39.
　WU Hai-bo,LIU Tong-yin,ZHU Wen-zhi.A Comparative Study of Basic Medical Insurance Control Models[J].Journal Press of Health Economics Research,2019,(10):36-39.
点击复制

基本医疗保险控费模式比较研究
分享到：

卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
期数:
2019年10期
页码:
36-39
栏目:
医保天地
出版日期:
2019-09-30

文章信息/Info

Title:
A Comparative Study of Basic Medical Insurance Control Models
作者:
吴海波1; 刘统银1; 朱文芝1
1.江西中医药大学经济与管理学院，江西 南昌 330004
Author(s):
WU Hai-bo; LIU Tong-yin; ZHU Wen-zhi
School of Economics and Management，Jiangxi University of Traditional Chinese Medicine，Nanchang Jiangxi 330004，China
关键词:
基本医疗保险; 过度医疗; 医保控费
Keywords:
basic medical insurance;  over-medical;  medical insurance fees control
分类号:
R197.1
文献标志码:
A
摘要:
近年来，我国基本医疗保险相关医疗费用支出快速增长，医保控费刻不容缓。当前，我国主要采取基于知识库的智能控费、PBM控费、DRG控费和AI控费等模式，各有优势与特色，但同时都存在不足。单纯依托一种控费模式是不够的，必须在加强分工协作的基础上，构建多元控费机制，形成全方位、多层次的控费体系，实现各控费模式的互补与衔接。
Abstract:
In recent years， China's basic medical insurance-related medical expenses have grown rapidly， and medical insurance fees control cannot be delayed. At present， China mainly adopts the knowledge base based on intelligent fees control， PBM fees control， DRG fees control and AI fees control， each with its own advantages and characteristics， but at the same time there are deficiencies. It is not enough to rely solely on one modes. On the basis of strengthening the division of labor and cooperation， we must build a multi-fee control mechanism to form a comprehensive and multi-level fees control system， and realize the complementarity and convergence of the various control modes.

参考文献/References:

[1] 马晓艳.美国药品福利管理（PBM）分析及对中国启示[D].广州：广东外语外贸大学，2017.
[2] 黎东生.中国式DRGs的控费机理及其控费效果的环境变量分析[J].中国医院管理,2018,38(3):43-45.
[3] 刘亚歌，彭明强.医疗保险费用支付方式改革对医院管理的影响[J].中国医院管理，2011,31（7）：52-54.
[4] 冯砾,陈立波,邱大江,等.基于人工智能的医保控费模式研究[J].劳动保障世界,2018(5):23-24.
[5] 金春林，何达. 人工智能在医疗健康领域的应用及挑战[J].卫生经济研究，2018（11）：3-6.
[6] 杨泽华，田侃，殷婷，等. 浅谈人工智能在我国卫生健康领域的应用[J].卫生经济研究，2018（11）：7-9,12.

相似文献/References:

[1]薛大东,皮 星,张培林.医疗服务供方声誉机制的形成障碍及政策建议[J].卫生经济研究,2016,(06):5.
[2]于保荣,柳雯馨,姜兴坤,等.商业保险公司承办城乡居民大病保险现状研究[J].卫生经济研究,2018,(03):3.
[3]贾洪波,段文琦.基本医保按病种分值付费的实践探讨[J].卫生经济研究,2018,(05):57.
[4]张籍元,马爱霞,唐文熙.典型省市大病保障模式探究[J].卫生经济研究,2019,(01):41.
　ZHANG Ji-yuan,MA Ai-xia,TANG Wen-xi.Study on the Mode of Major Illness Insurance in Typical Provinces[J].Journal Press of Health Economics Research,2019,(10):41.
[5]李乐乐,俞 乔.云南省玉溪市DRGs付费改革的实践探索[J].卫生经济研究,2019,(03):47.
　LI Le-le,YU Qiao.Practice Exploration of DRGs Payment Reform in Yuxi City，Yunnan Province[J].Journal Press of Health Economics Research,2019,(10):47.
[6]郑慧凌,苏敏艳,吴晶晶,等.基本医疗保险对居民诊疗费用影响研究——基于供给和需求的视角[J].卫生经济研究,2019,(06):42.
　ZHENG Hui-ling,SU Min-yan,WU Jing-jing,et al.Study on the Impact of Basic Medical Insurance on Residents' medical Expenses——Based on Supply and Demand Perspective[J].Journal Press of Health Economics Research,2019,(10):42.
[7]王毓丰,陈永法.商业保险衔接基本医疗保险的国际经验及启示[J].卫生经济研究,2019,(09):60.
　WANG Yu-feng,CHEN Yong-fa.International Experience and Enlightenment of Linking Basic Insurance to Commercial Insurance[J].Journal Press of Health Economics Research,2019,(10):60.
[8]贾洪波.基本医疗保险制度可持续发展的功能定位与新作为[J].卫生经济研究,2019,(12):33.
　JIA Hong-bo.Functional Positioning and New Role of Sustainable Development of Basic Medical Insurance System[J].Journal Press of Health Economics Research,2019,(10):33.
[9]朱 坤,林 玲.我国基本医疗保险筹资机制研究[J].卫生经济研究,2020,(08):17.
　ZHU Kun,LIN Ling.Research on the Financing Mechanism of Basic Medical Insurance in China[J].Journal Press of Health Economics Research,2020,(10):17.
[10]赵钦风,李佳婧,焦 晨,等.慢性病患者家庭发生灾难性卫生支出研究[J].卫生经济研究,2021,38(2):7.
　ZHAO Qin-feng,LI Jia-jing,JIAO Chen,et al.Study on Catastrophic Health Expenditure in Families of Chronic Diseases Patients[J].Journal Press of Health Economics Research,2021,38(10):7.

更新日期/Last Update: 2019-09-30