门诊统筹模式的建立与思考

Establishment and Consideration of Pooling Funds of Outpatient Service

为探讨门诊统筹模式及其构建过程中存在的问题,本研究在文献研究和对江苏省部分城市医疗保险实证分析的基础上,提出了利用个人账户、构建门诊统筹与社区卫生服务相结合的模式,并从其基金筹集渠道、保障范围、统筹待遇及费用分担机制、结算方式及基金管理5个方面进行了论述;采用SWOT分析,从优势、劣势、机会和威胁方面对门诊统筹构建的内外环境进行了全面分析,论证了上述模式在实际运行中的可行性,并提出了在门诊统筹构建过程中需要注意门诊统筹基金风险的管理与控制,门诊统筹与社区卫生服务的有效衔接以及配套政策、制度和技术的问题。

In order to explore the issues existing in the development and construction of pooling funds of outpatient service model,in this pare,we bring forward a model using individual account to build the combining pooling funds of outpatient service with community health service on the basis of the literature research and empirical analysis of medical insurance of some cities in Jiangsu province.We discuss it from five points of capital source,coverage,treatment and expense sharing mechanism,the method of payment ...