澳大利亚医保支付方式改革及对我国的启示

The reform of Australian medical insurance payment methods and its implications for China

目的:通过研究澳大利亚医保支付方式演变过程以及改革主要特点,以期为我国医保支付方式改革提供有价值的建议。方法:通过文献研究的理论方法分析了澳大利亚医保支付方式的演变过程以及改革的特点。结果:澳大利亚医保支付方式改革主要分为三个阶段,主要是按服务项目付费、总额预付制以及按病例组合付费方式。同时其医保支付方式改革的特点主要是由后付制转变为预付制、建立精细化分类管理、关注医疗服务质量安全。结论:澳大利亚的医保支付方式改革对我国具有重要借鉴意义,但仍需结合本国国情,探索具有中国特色的复合型医保支付方式。

OBJECTIVE To provide valuable suggestions for the reform of medical insurance payment mode in China by studying the evolution process of medical insurance payment mode in Australia and the main characteristics of the reform.METHODS Based on literatures,the evolution process of Australian medical insurance payment methods and the characteristics of reform have been researched.RESULTS The reform of health insurance payment mode in Australia was mainly divided into three stages,mainly including payment by service item,total prepaid system and payment mode by case combination.At the same time,the characteristics of the reform of medical insurance payment mode are mainly changing from after-payment system to prepaid system,establishing refined classified management,and paying attention to the safety of medical service quality.CONCLUSION The reform of medical insurance payment methods in Australia has important reference significance for China.However,China still needs to explore the composite medical insurance payment methods with Chinese characteristics in light of its national conditions.