我国医共体医保制度改革进展及其影响分析

Analysis on the Progress and Its Influence of the Medical Insurance System Reform of Medical Alliance in China

医保制度改革是医共体整合的核心,包括总额测算方式、医保资金分配、医保支付方式和支付标准、资金结余分配及超支分担、配套考核等,都会对医共体利益相关者(政府部门、医疗机构、医务人员和患者等)产生影响。当前医共体医保制度改革的难点和重点在于进一步完善总额测算方法、探索疾病全程管理的捆绑支付、建立多层面的配套考核机制等。

The medical insurance system reform is the core of the medical alliance’s integration,including global budget method,medical insurance fund allocation,medical insurance payment method and payment standard,fund balance allocation and over-expenditure sharing,supporting evaluation and so on,and these factors will have influence on the stakeholders of the medical alliance(government departments,medical institutions,medical staffs,patients and so on).At present,the difficulty and focus of the medical insurance system reform of medical alliance is to further improve the global budget method,explore the bundled payment of the whole processing management of diseases,and establish a multi-level supporting evaluation mechanism.