医保整体支付背景下医疗共同体牵头单位面临的挑战与对策

Challenges and countermeasures faced by leading units of county medical alliance under the background of overall payment of medical insurance

医保部门将医疗共同体整体作为支付对象,使牵头单位在资金统筹、资源分配等方面面临着严峻挑战。作者总结分析了典型地区医疗共同体牵头单位在整体支付实施后面临的基金超支风险大、额外医疗风险高、专项资金管理难等问题,提出了实现利益责任统一、下放医保结算权、医保支付精细化、基层医疗服务定价改革等解决措施,以期为完善医疗共同体医保支付政策、进一步推动医疗共同体建设发展提供参考。

Leading units of county medical alliance had difficulties in financial management and resource distribution after social medical insurance took the whole alliance as the payment subject.The authors summarized and analyzed the problems faced by the leading units of medical alliance in typical areas after the implementation of the overall payment,such as the high risk of fund overspending,the high risk of extra medical treatment,and the difficulty in the management of special funds.Then put forward some solutions,such as the unification of interests and responsibilities,the decentralization of medical insurance settlement rights,the refinement of medical insurance payment,and the pricing reform of primary medical services,so as to improve the medical insurance payment policy and promote the development of county medical alliance.