美国老年医保按病种付费支付标准借鉴与启示

Practices and inspirations of the DRGs payment rate calculation for seniors medical insurance in the United States

从正常病例和异常病例的界定开始，系统分析了美国老年医保按病种付费对于正常病例和异常病例基础支付标准和附加支付标准的制定方法，认为我国应当注重提高付费方式转换的平稳性，调动医疗机构的积极性；要重视医疗机构之问的差异性，实现医保的精细化管理。

In terms of the definition of normal cases and abnormal ones, the paper systematically analyzed the DRGs payment for American seniors Medicare, focusing on the mechanism of the basic payment rate and additional payment rate for normal and abnormal cases. These experiences prompt to maintain the stability of the payment modes transition, motivate medical institutions, and pay attention to differences among such institutions for fine management of medical insurance.