德国医疗保险支付方式改革及对我国的启示

Reform of medical insurance payment methods in Germany and its enlightenment to China

研究德国医疗保险(以下简称"医保")支付方式由总额预付制过渡到按疾病诊断相关分组(diagnosis related group,DRG)付费制度的改革历程,深入探讨其驱动因素,为我国医保支付方式改革提供借鉴。德国医保支付方式改革过程较为缓和,各利益相关方参与度较高,这使得医保费用得到控制。我国的医保支付方式改革应借鉴德国经验,把握改革的总体趋向,从后付制向预付制转变,继续以总额预付为基础,逐步推行按DRG付费制度,同时针对医疗卫生机构建立规范合理的激励与约束机制,最终实现全国医保支付方式改革。

The reform of medical insurance payment methods in Germany from global budget to payment by diagnosis related group was studied,and the driving factors were explored,which provided references for the reform of medical insurance payment methods in China.The reform of payment methods in Germany was relatively moderate,and the participation of various stakeholders was relatively active,which all helped contain the health expenditures.China should learn from the reform experience of Germany,transforming retrospective payments to prospective payments.Payment by diagnosis related group should be applied gradually with the implementation of global budget payment.At the same time,a standardized and reasonable incentive and restraint mechanism for medical institutions should be established to realize the reform of medical insurance payment methods at the national level.