为医保收支平衡提供稳定的环境：“总额预算＋按服务单元付费”组合支付方式预期效果之五

Expected effects of the mixed payment of"Global budget and Service unit"(Ⅴ):providing a balanced environment between financing and expenditures for insurance fund

从组合支付方式设计原理出发,利用我国常规统计数据进行论证,发现"总额预算+按服务单元付费"组合支付方式下,明确设立医疗机构业务收入的总额及按GDP同步增长的增速指标,医疗费用支出可预测、可调控,能确保医保费用支出与筹资基本同步,为医保基金收支平衡提供稳定的环境。另外,由于对每次服务实行定额收费,所以易于与医保给付方式接轨,收支平衡补偿方案容易制定。由此,医疗保障部门担忧的收支失衡问题得以彻底解决。

According to the design principle of the payment,through qualitative analysis and quantitative simulation by conventional statistical report data,the paper discovered that under the mixed payment of ＂ Global budget and Service unit＂,the total amount of operating revenue of hospitals is fixed and allowed to increase with GDP.Therefore,the medical expenditure is predictable and controllable,and there will be a balanced environment between financing and expenditures for insurance fund.Meanwhile,under the fixed fee per service unit,it is convenient for Department of Medical insurance to integrate with compensatory pattern and to adjust their compensation package to keep balance between financing and expenditures.As a result,the most difficult problem of imbalance between financing and expenditure,from which Department of Medical insurance suffers,can be completely resolved.