医保费用总额控制支付方式的实施效果分析

Analysis of the Effect of Medical Insurance Scale Payment

为了评价医保费用总额控制对医药费用及医疗机构经济运行的影响,文章选取了四川省若干家具有代表性的医疗机构,对实施总额控制的医疗机构和未实施总额控制的医疗机构进行对比。结果表明,总额控制下,费用控制效果不明显,且在一定程度上影响了医疗质量,限制了医疗机构的发展。在完善总额控制方面,应建立"结余共享"及"风险共担"制度,逐步实现由后付制向预付制转变。

Through the eompansion between medical institutes, which carrying out medical scale payment, and which not carrying out it, effect of medical insurance scale payment is evaluated based on the data of representative hospitals in Siehuan Porvinee. Results show that the effect of scale payment on expense control is not obvious, and this method affeetes the quality of care, limits the development of medical institutions to some extent. So ＂share balance＂ ＆ ＂ risk sharing＂ system and payment in advance method shouht be established.