美国医保DRG支付方式对我国医保支付方式选择的启示

Thinking about the payment means from DRG health insurance system in USA to urban employers' health insurance system in China

通过对美国医疗保险DRG支付方式的分析和评价 ,不仅指出了美国医疗保险DRG支付方式的核心支撑体系是价格 ,是从医疗保险角度所设立的“医疗保险价格”的新理念 ,而且还指出了我国医疗保险支付方式选择的思路 :以总额预付制为基础 ,进行预付制与后付制的有机组合 ;根据医疗服务的多样性应用多种支付方式 ;建立医疗保险价格体系 ;建立质量评估监测体系 ,结合质量校正系数调整给付费用。

Analyzing and evaluating the payment means of Diagnosis Relate d Group (DRG),Which isthe health insurance system in USA,and the view is offered: the ke y issue of DRG system is price, the new concept of “health insurance price' established i n terms of health insurance system. The alternatives of payment under Chin ese he alth insurance system is suggested: based on the total pre-service payment, com bination of pre-service payment and post-service payment; diverse approaches bas ed on the multi-health-services; the establishment of medical insurance price sy stem; the establishment of quality monitoring & evaluating system which should b e combined with the quality adjustment coefficient to adjust the value of paymen t.