摘要
探索我国按疾病诊断相关分组付费模式下医保基金监管机制,有助于促进诊疗行为规范,提高基金使用效率,确保基金安全和参保人的权益。文章通过文献研究,分析并借鉴国内外医保基金监管机制。建议完善医保基金监管体系,加强多方协同联动机制;构建以结果为导向、以过程监管为核心的监管指标体系,建立智能监管系统;日常监管与定期评价相结合,建立按疾病诊断相关分组付费下基金监管绩效考核机制。
Exploring the supervision mechanism of medical insurance funds under the DRG payment model in China will help to promote the diagnosis standardization,improve the efficiency of fund use,and ensure the safety of funds and the rights and interests of insured persons.It analyzes and draws lessons from the domestic and foreign medical insurance fund supervision mechanism through literature research.It is recommended to improve supervision system of the healthcare security fund,strengthen the multi-party coordination and linkage mechanism,establish a result-oriented supervision index system with process supervision as a core,build an intelligent regulatory system,combine daily supervision with regular evaluation,and establish a performance assessment mechanism under DRG payment.
作者
程斌
朱兆芳
崔斌
史纪元
孙谦
杨琳
王淞
CHENG Bin;ZHU Zhao-fang;CUI Bin(China National Health Development Research Center,Beijing,100044,China;不详)
出处
《中国卫生经济》
北大核心
2022年第9期33-36,共4页
Chinese Health Economics
关键词
按疾病诊断相关分组
医保支付方式改革
医保基金监管机制
Diagnosis Related Group
the reform of medical insurance payment system
the supervision mechanism for the medical insurance
