深圳总额控制下复合式医疗保险支付制度的实践

Practice of the compound medical insurance payment system under a ceiling control in Shenzhen

介绍了深圳市医疗保险的支付方式，概括为“总额控制、年初预付、方式多样、按月支付、年终总算、结余有奖”。通过加强付费总额控制、采用复合式支付方式、科学合理确定付费标准、建立完善监控体系等，深圳医保支付制度改革取得了明显的效果：参保人享受到基本医疗保障、医保基金收支平衡、医疗费用过快增长得到遏制、推进了“社区首诊制”、促进了医疗卫生事业发展以及参保人满意度逐年提高。

The paper summarized the compound medical insurance payment system under a ceiling control with Shenzhen characteristics. This practice features ＂ceiling control, prepaid at year beginning, multiple payment methods, monthly payment, year-end closing, and reward＂ for surplus. The following measures have been implemented, namely controlling the total amount, compound payment mode, setting up the scientific and reasonable payment standards and establishing a perfect supervision system. This reform has achieved such outcomes as accessibility of the insured people to primary medical insurance, balance for the medical insurance fund, curbing of rapid rise of medical expenses, progress in the policy of first contact in the community health organization, promoting the development of the health system and raising satisfaction among the insured people year by year.