整合医疗及财务体系探讨

Discussion on integrated healthcare and finance system

整合医疗及财务体系是一种新兴的医疗健保整合模式,旨在将卓越的临床服务和激励机制有机地结合在一起,从而提供高质量医疗并降低费用。整合医疗及财务体系采用医险结合模式,重视基础保健,并推进全面信息化,从而降低成本的同时提高效率和质量。国外应用实践证明,通过采用整合医疗及财务体系,服务范围扩大到疾病预防、社区初诊、常规急诊治疗、专科诊治及后续一整套康复服务,提高效率的同时显著降低医疗成本,更重要的是可以有效改善患者预后。目前国内也在逐渐了解并接受整合医疗及财务体系理念,通过推动以价值为导向的医疗,鼓励商业医疗保险并进行医保整合,将有助于医疗的良性循环,从而全面推进“健康中国”建设。

Integrated healthcare and finance system is a new mode of managed care which can both provide qualified healthcare and reduce medical cost by integrating excellent healthcare provision and incentive mechanism. The mode integrates healthcare provision and healthcare insurance. By the measures of highlighting on primary healthcare and information technology, medical cost has been reduced and the efficiency and quality has been increased. Foreign countries’ experiences show that under integrated healthcare and finance system mode, by integrating disease prevention, community healthcare, emergency care, special care and series of rehabilitation care, the efficiency has been improved, the cost has been reduces and patient’s benefit also has been effectively increased. The principle of integrated healthcare and finance system has been gradually accepted in China. By promoting value oriented healthcare, encouraging commercial medical insurance participation, healthcare system can be improved which can help full promoting ‘Health China’ construction.