医保付费制度改革中的逆向效果与对策研究

Reverse effects and countermeasures in the reform of medical insurance payment system

医保付费制度改革是我国医疗体制改革的重要组成部分,对于优化医疗资源配置,遏制不合理费用支出,减轻患者负担起到了积极作用,但医保付费制度改革也引发了逆向效果的产生,带来新问题。研究阐述了医保付费制度改革逆向效果产生的背景、原因及表现形式,分析并提出建立科学的医保基金预测制度,构建“患者-医院”的双向监督制与第三方医保付费监管机制,实现患者与医疗机构的利益双向协同化等建议,以减少医保付费制度改革中的逆向效果与不利影响。

Medical insurance payment system reform is an important part of China’s medical system reform. It has played a positive role in optimizing the allocation of medical resources, curbing unreasonable expenditure and lightening the burden of patients. However, the reform of medical insurance payment system has also resulted in adverse effects and brought new problems. This paper expounds the background, causes and manifestations of the adverse effects of the reform of the medical insurance payment system, analyzes and puts forward some suggestions on establishing the forecasting system of the medical insurance fund, constructing the two-way supervision system of “patient-hospital” and the third-party medical insurance payment supervision mechanism, realizing the two-way coordination of the interests of patients and medical institutions, so as to reduce the risks and adverse effects in the reform of medical insurance payment system.