医保支付激励整合医疗服务的逻辑与实现路径

The Logic and Pathway of Medical Insurance Payment Incentivizing Integrated Medical Service

近年来,欧洲国家广泛实施的按协调付费、按绩效付费和捆绑付费等支付机制,在促进供方合作、提供高质量和连续性服务等方面有积极作用。在我国,按项目付费为主的医保支付机制尚未完全改变,支持整合医疗服务的政策环境也不成熟,需要加快推进混合预付制改革,强化医保支付的经济激励功能,建立联通共享的患者信息数据库,完善整合医疗服务的政策环境,充分发挥医保支付激励整合医疗服务的效能。

In recent years,European countries have widely implemented several payment schemes such as pay-for-coordination,pay-forperformance,and bundled payment.These schemes have played a positive role in promoting supplier cooperation and providing high-quality and continuous services.In our country,fee-for-service payment has not yet been completely changed,and the policy environment to support integrated medical services is not mature.It is necessary to accelerate the reform of mixed prospective payment,strengthen the economic incentive function of medical insurance payment,establish interconnected and shared patient information database,and improve the policy environment for integrated medical services,so that the incentive effect of medical insurance payment on integrated medical services can be fully utilized.