湖州市医共体综合付费方式改革的经验和启示——以德清县为例

Experience and Enlightenment of Comprehensive Payment Method Reform in Huzhou Medical Alliance——Taking Deqing County as Example

浙江省德清县实施医共体总额预算下门诊按人头付费、住院按DRG付费的医保支付方式改革,形成了具有地方特色的改革经验,但同时也面临医保基金抗风险能力较弱、参保人员就医偏好尚未出现拐点等挑战。对此,需提高统筹层次,增强医保基金抗风险能力;因时因地调整支付方式,进一步完善“总额预算、结余适当留用、超支合理分担”机制。

Deqing County in Zhejiang Province has implemented the medical insurance payment method reform,including outpatient payment by capitation and hospitalization payment by DRG under the global budget of the county-level medical alliance,which has formed the reform experience with local characteristics,but it also faces the challenges such as the weak anti-risk ability of the medical insurance fund and the lack of turning point of the insured's medical preference.In this regard,it is necessary to improve the pooling level,enhance the anti-risk ability of the medical insurance fund,adjust payment method according to situation and further improve the mechanism of"global budget,appropriate retention of balance,reasonable sharing of over expenditure".