实施医保付费总额控制的初步效果——基于重庆市的实践

The Preliminary Achievement of Implementing Gross Payment Control Method——Based on the Practice of Chongqing

重庆市从2009年开始探索医保付费总额控制,几年来的实践证明,总额控制对健全医疗机构内部管理机制,合理控制医疗费用,提高医疗服务质量,保障参保人员权益,减轻参保人员个人负担发挥了积极作用。实施总额控制,要准确领会其基本要义,抓好摸底、谈判和协议管理等重点环节,科学设置质量考核指标,完善配套措施,争取社会各界的支持。

A new method of settling medical insurance accounts which named the Gross Payment Control has being implemented in Chongqing since 2009. A four year＇s practice proved that the Gross Payment Control method has many advantages, which include but not limit to enhancing the inner management of hospitals and clinics, limiting the medical expenses in a reasonable range, improving the quality of medical services, guaranteeing the rights and interests of insured people, and relieving the financial burden of insured people. To achieve a successful Gross Payment Control, the medical insurance administrations should understand its basic idea, investigate the medical market, lead the contract negotiation, set a scientific performance assessment criteria, enhance the supporting policies and seek supports from the whole society.