上海医保付费制度改革回顾与展望

Review and Prospect of Medical Insurance Payment System Reform in Shanghai

本文回顾了上海医保付费制度改革历程,对推进医保总额预算管理、建立医保预付机制、探索多种医保支付方式等取得的主要成效和面临的发展形势进行了深入分析;并从完善医保付费管理体系、推进医保总额预算精细化管理、强化对医保费用支出的监管、探索适应医改发展要求的医保付费管理制度等方面,对医保付费制度改革的前景进行展望。

This paper reviewed the history of medical insurance payment system reform in Shanghai, analyzed the achievements and development situation in the promotion of the total budget management, the establishment of medical insurance payment mechanism and the exploration of different medical insurance payment methods. The author also prospect the medical insurance payment system reform in Shanghai from the perspectives of improving the management of medical insurance payment system, promoting the delicacy management of total health care budget, strengthening the supervision of medical care expense and making it suitable for the requirements of health care reform.