医保助推三医联动重在建立机制——以金华医保为例

Medical Insurance Focus on Mechanism Construction to Boost the Tripartite Reform in Health System

三医联动难揭示了我国卫生体制和医保运行机制的问题。目前,国家卫计委在开展医院DRG质量评估和医疗DRG收费方式改革,人社部的责任是开展医保DRG-PPS付费方式改革,进而在二者之间建立平等协商和公平定价的社会治理机制。本文以金华医保支付方式改革为例,看医保支付方式改革在宏观调控费用增长率、中观引导医疗机构有序竞争和微观奖惩医疗机构成本管理的机制建设。

The diffi culty to promote the tripartite reform in health system reveals the problem in China’s health system and health insurance operation mechanism.Currently,the National Health and Family Planning Commission is carrying out the DRG quality assessment and DRG payment reform,while the Ministry of Human Resources and Social Security is responsible for the DRG-PPS payment reform in health insurance.The next step is to establish a social governance mechanism based on equal consultation and fair pricing.This paper takes the Jinhua medicare payment reform as an example to explore the role of health insurance payment reform playing in controlling the cost growth rate on macro level,guiding the orderly competition on medium level,and constraints of cost management mechanism of medical institutions on micro level.