地区医保支付方式改革的制度设计及公立医院运营管理的对策建议

A System Design for the Reform of Medical Insurance Payment in a Region and Suggestions of Countermeasure for Public Hospitals' Operation Management

该文从Y市现行的医疗保险支付方式改革入手,分析改革的动因、举措和存在的问题,借助"利益相关者"理论,提出地区医疗保险支付方式的制度设计思路,同时对公立医院主动应对医疗保险支付方式改革、加强内部管理、提高运营效率、改变诊疗行为模式等方面提出建议。

The article, from the Y City＇s the current medical insurance payment reform, analyzed the reform motivations, initia- tives and problems, and with ＂ stakeholder＂ theory, it further put forward the system design ideas of regional medical insurance payment, made recommendations for public hospitals to take initiatives to deal with health care insurance payment reform, to strengthen internal management, to improve operational efficiency, and to change behavior patterns of diagnosis and treatment.