[1]宋生来,胡小波,胡晓彦.湖州市医共体综合付费方式改革的经验和启示——以德清县为例[J].卫生经济研究,2021,38(12):25-28.
　SONG Sheng-lai,HU Xiao-bo,HU Xiao-yan.Experience and Enlightenment of Comprehensive Payment Method Reform in Huzhou Medical Alliance——Taking Deqing County as Example[J].Journal Press of Health Economics Research,2021,38(12):25-28.
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湖州市医共体综合付费方式改革的经验和启示
——以德清县为例
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卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
38
期数:
2021年12期
页码:
25-28
栏目:
地市经验
出版日期:
2021-12-02

文章信息/Info

Title:
Experience and Enlightenment of Comprehensive Payment Method Reform in Huzhou Medical Alliance
——Taking Deqing County as Example
作者:
宋生来1; 胡小波2; 胡晓彦1
1.浙江省德清县医疗保障局，浙江 德清313200
2.浙江省湖州市医疗保障事业管理服务中心，浙江 湖州 313000
Author(s):
SONG Sheng-lai;  HU Xiao-bo;  HU Xiao-yan
Medical Security Bureau of Zhejiang Deqing, Deqing Zhejiang 313200, China
关键词:
医保支付方式改革; 医共体; 总额预算管理
Keywords:
medical insurance payment method reform;  county-level medical alliance;  global budget management
分类号:
R197
文献标志码:
B
摘要:
浙江省德清县实施医共体总额预算下门诊按人头付费、住院按DRG付费的医保支付方式改革，形成了具有地方特色的改革经验，但同时也面临医保基金抗风险能力较弱、参保人员就医偏好尚未出现拐点等挑战。对此，需提高统筹层次，增强医保基金抗风险能力；因时因地调整支付方式，进一步完善“总额预算、结余适当留用、超支合理分担”机制。
Abstract:
Deqing County in Zhejiang Province has implemented the medical insurance payment method reform, including outpatient payment by capitation and hospitalization payment by DRG under the global budget of the county-level medical alliance, which has formed the reform experience with local characteristics, but it also faces the challenges such as the weak anti-risk ability of the medical insurance fund and the lack of turning point of the insured's medical preference. In this regard, it is necessary to improve the pooling level, enhance the anti-risk ability of the medical insurance fund, adjust payment method according to situation and further improve the mechanism of "global budget, appropriate retention of balance, reasonable sharing of over expenditure".

参考文献/References:

[1] 姚水龙.德清县医保助推分级诊疗的实践探索[J].中国医疗保险，2020（7）：45-48.
[2] 江蒙喜.县域医共体改革发展效果的评价指标体系构建——基于浙江省德清县的案例研究[J].卫生经济研究，2018（12）：11-13.
[3] 徐烨云，郁建兴.医保支付改革与强基层战略的实施：浙江省县域医共体的经验[J].中国行政管理，2020（4）：102-108.

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更新日期/Last Update: 2021-12-02