深圳市医疗保险服务结算办法述评

An evaluation on the clearing system of health insurance service in Shenzhen

以何种方式与医疗单位结算,一直被认为是困扰医疗保险改革的难点。深圳市自1992年8月以来,对医疗单位实行了按项目、服务医疗单元、病种、人头4种付费结算方法,通过几年的实践看,各有其利弊。本着去弊存利的原则,并结合改革实践提供的启示,提出了实行医疗保险结算办法的三个设想:一是实行个人医疗帐户与社会共济相结合的医疗模式;二是完善住院"平均费用标准"结算办法;三是进一步探索按病种结算的办法。

The question of how to settle accounts with medical units has been a difficult one the re- form of medical insurance faces.Since August 1992,Shenzhen has used a clearing system on the basis of four components:service items,service units,disease specification and the number of people. Through years of practice,such a system has both strong and weak points.Based on the principle of re- taining the former and doing away with the latter and on the experience drawn from the practice of re- form,three new ideas on the clearing system have been put forward.One is the combination of personal account with the social insurance fund.The other is the perfection of hospitalization clearing on the 'av- erage cost standard'.The third one is a further study of a clearing system on the basis of disease specifi- cation.