医疗保险基金现代易货偿付模式的可行性

Feasibility study on modern barter payment mode of medical insurance fund

该文结合我国城镇职工基本医疗保险制度实施几年来的现状,以医疗保险学的供给与需求理论为基础,深刻分析了定点医院与医保管理部门之间的矛盾、定点医院与参保患者之间的矛盾,指出了现行的医疗保险基金偿付模式下难以根治的弊病。通过实地调查,展开探索性研究,并对有关资料定性分析,总结出采用医疗保险基金现代易货偿付模式,能够保证医疗保险基金的保值与增值,在医疗保险基金收支平衡的前提下,可实行"总量预算、预付额度、重病定补、弹性结算和部分疾病按病种付费相结合"的复合式结算办法,通过集中招标采购将满足基本医疗需求并质优价廉的药品和医用材料纳入现代易货交易,最大限度地维护定点医院和参保患者的权益。

Combining with the present situation of China＇s urban and township basic medical insurance system, which has been put into practice for several years, based on the supply and requirement theory of medical insurance science, this essay analyses deeply the contradiction between designated hospitals and the medical insurance administrative department, the contradiction between designated hospitals and insurants.h points out the disadvantages,which cannot be easily solved fundamentally, under the payment of the present medical insurance fund. By way of field research, the authors made exploration research and analyzed some relevant qualitative data.Therefore, the authors conclude that its value and increment could be ensured if modern barter mode of payment of medical insurance fund would be adapted. On the premise of a balance between receipts and payments, a combined type of clearing form could be performed.Under the fund balanced budget, basic cure＇s requirement could just be satified. And if medicine and medical material of super quality and competitive price would bring into modern barter bargain, the fights and interests of designated hospitals and insurants could be maximumly protected.