北京医保定点管理实践与“十三五”思路探讨

The Practice of Delicacy Management of Medical Insurance in Designated Health Care Institutions of Beijing and Exploring Ideas for the "Thirteenth Five-year"

"十二五"期间,北京市对定点医疗机构加强精细化管理,通过支付制度改革、数据挖掘、加强监管和信息化建设,遏制了医疗费用快速增长,实现了医保基金平稳运行。但基金收支平衡和可持续的压力叠加,支出结构性问题突出。"十三五"时期将在继续"改革医保支付方式,发挥医保控费作用"上加大力度,创新精细化和精准管理,实现医保事业公平可持续发展。

During the period of the ＂Twelfth Five-Year＂, a delicacy management of medical insurance in designated health care institutions, which included payment system reform, data mining, strengthening supervision and information construction, has been taken in Beijing. As a result, we have contained the rapid growth of medical expenses, and ensured the stable operation of medical insurance funds. However, there are still problems in fund balance, sustainability, expenditure structures. During the period of the ＂Thirteenth Five-year＂, we will keep on strengthening the efforts to reform payment methods and make medical insurance play roles in controlling medical expense, and innovate refined and precise management to achieve the goal of sustainable development of medical insurance business.