支付制度改革一个年度的评析——以河南省省直医保为例

Analysis of Payment System Reform Through A Year —— Based on the Practice of Henan Provincial Medical Insurance

2012年结算结果显示:河南省省直医保通过一年的支付制度改革,在政策规定范围内报销比例提高5%的情况下,统筹基金支出增长由年均46%下降到11%,扭转了统筹基金连续两年当期收不抵支的局面,当年结余5495万元。但医保经办机构如何加快实现由"付费方"向"购买方"的转变、如何发挥医疗机构医保管理者的作用,如何破解总额控制下出现的推诿患者等问题,仍然亟待深入研究。

The balance account of 2012 shows that through one-year reform of medical payment system, the growth of fund expenditure of Henan provincial medical insurance decreased from 46% to 11%, with the reimbursement ratio increasing by 5%, which reversed the situation of two consecutive years loss. And the surplus reached 54.95 million RMB. However it＇s still to be studied for medical insurance agencies that how to change form the ＂payer＂ to ＂buyer＂, how to play the role of supervisor, and how to prevent hospitals from declining patients under the control of total payment.