新三医联动模式下的医疗保险付费方式改革探讨

Exploration on Payment Mode Reform under the New Tripartite System Reform Model

医疗保险付费方式改革是新三医联动模式的重要内容。买方花钱办事理论是医疗保险付费方式改革的分析工具,也是医疗保险付费方式改革的指导思想。买方花钱办事理论是指"花谁的钱"决定医保机构控费动力,"办谁的事"决定医保机构保质动力的基本原理。本文依据买方花钱办事理论分析了医疗保险各付费方式的功能优劣、医疗保险付费方式改革的主要方向和配套制度,提出了医疗保险付费方式的功能定位、医疗服务体制机制的角色定位、医疗服务体制机制与医疗保险付费方式的相互关系,为新三医联动模式下医疗保险付费方式改革提供理论参考。

The medical insurance payment mode reform is the important content of the New Tripartite System Reform model. The ＂buyer＇ s spend - money and handle - affairs＂ theory is the diagnostic tool and the guiding ideology of medical insurance payment model reform. The basic principle of the ＂buyer＇ s spend - money and handle - affairs＂ theory is ＂who spends money＂ decides the cost control power of medical insurance institutions, and ＂who handles affairs＂ decides quality guarantee power of medical insurance institutions. Based on the ＂buyer＇s spend -money and handle - affairs＂ theory, this＇paper analyzes the pros and cons of medical insurance payment mode function, the main direction and accompanying institution of medical insurance payment mode reform, and proposes the function of medical insurance payment, the role of medical service system and the mutual relationship between medical service system and medical insurance payment method, to provide theoretical reference for medical insurance payment method reform under the New Tripartite System Reform model.