医疗保险总额预算控制下的按服务单元浮动付费制:机遇与挑战并存

The Service Unit Floating Payment System under the Total Budget Control of Medical Insurance:opportunities and challenges coexist

目的:了解总额预控下的按服务单元浮动付费方式对医疗机构可能造成的影响,并探讨应采取的可行性措施。方法:通过对政策的解读,与单纯按定额浮动结算政策进行比较来了解新政策的特点。结果:新政策通过总额预控能有效抑制医疗费用过快增长的趋势,引入的人次人头比指标,有效控制了医疗机构分解就医人次的行为。结论:医疗机构通过加大费用控制管理力度,开展新业务以吸引人头就医,优化医疗收费结构构成,能实现医疗业务稳步增长。

Objective： To find out effects of the service unit floating payment system under the total budget control of the medical institution, and explore feasible solution. Methods： Through interpretation of the policy, compare with simple service unit floating payment system to find out the characteristics of the new policy. Results： Through the total budget pre-controt system, the new policy can effectively restrain the trend of fast growing on medical expenses. Time of doctor and number of patient ratio indicators are introduced to effectively prevent the medical institution decompose the time of doctor. Conclusion： To achieve the steady growth of medical business, medical institutions need to enhance the management of expense control, develop new business to attract new patients, optimize the medical charge structure.