我国医保支付方式改革的运行逻辑、影响机制与实施效果分析

Analysis on the Operation Logic,Influence Mechanism and Implementation Effect of Payment Mode Reform of Medical Insurance in China

通过对门诊与住院支付方式进行比较分析,结合我国门诊与住院支付方式改革城市的试点经验,总结我国医保支付方式改革的运行逻辑、影响机制与实施效果。为推动建立健全管用、高效、多元复合的医保支付方式,实现“分类结算、协同推进”的医疗服务综合治理机制,提高医保资金使用效率,为保障人民群众的生命健康提供经验参考。该文章从政策层面、技术层面和基金层面,提出优化我国医保支付方式改革治理路径的相关政策建议。

Based on the comparative analysis of outpatient(Ambulatory Patient Groups,APG) and inpatient(Diagnosis Related Groups,DRG/Diagnosis-Intervention Packet,DIP) payment methods,combined with the pilot experience of outpatient and inpatient payment method reform cities in China,it summarizes the operation logic,impact mechanism and implementation effect of medical insurance payment method reform in China.It provides empirical support for promoting the establishment and improvement of effective and efficient multi-compound medical insurance payment methods,realizing the comprehensive medical service management mechanism of "classified settlement and coordinated promotion",improving the efficiency of medical insurance funds,and ensuring residents’ lives and health.Finally,from the policy level,technical level and fund level,it puts forward relevant policy suggestions on optimizing the governance path of Chinese medical insurance payment mode reform.