医保支付方式在助推分级诊疗中的作用

Effect of Medical Insurance Payment in Promoting Hierarchical Diagnosis and Treatment

坚持基层首诊、双向转诊、急慢分治、上下联动的就医程序,助力分级诊疗建设是医改的一项重要任务。医保支付方式作为重新配制医疗资源、调控供方医疗行为与需方就诊行为的有力杠杆,在一定程度上对分级诊疗有促进作用。本文总结了分级诊疗的现状,进一步分析通过需方(参保人)引导和供方(医疗机构)引导的医保支付方式在助推分级诊疗中的做法与作用。

It is an important task of medical reform to uphold the order of primary medical treatment at the community level,two-way referral,separation of emergency and chronic treatment,and linkage between the upper and lower levels,and to promote hierarchical diagnosis and treatment.As a powerful lever to reconfigure medical resources and regulate the medical behavior of the supplier and the medical behavior of the demander,the medical insurance payment mode can promote the hierarchical diagnosis and treatment to a certain extent.This article summarizes the current status of hierarchical diagnosis and treatment,and further analyzes the practice and role of medical insurance payment mode guided by demander(insured)and provider(medical institution)in promoting hierarchical diagnosis and treatment.