我国几种医保付费方式的特点和问题研究

Study on the characteristics and problems of several medical insurance payment modes in China

深化医保付费方式改革,提高医疗保障基金使用效率,保障医、保、患权益是医保改革重中之重。目前,我国医保基金收支不平衡、医疗费用增长过快、医疗质量难以保证。为此,我国试图通过医保付费方式这个杠杆保障三方权益。本文总结我国主流的医保付费方式(如按项目付费、按人头付费、按服务单元付费、按病种付费)的特点并提出了解决当前医保付费方式困境的建议,为推广多元复合式的医保付费方式提供理论依据。

Deepening the reform of medical insurance payment method,improving the efficiency of medical insurance funds,and protecting the equity of medical care,insurance,and patients are the top priorities of medical insurance reform.At present,medical insurance funds are unbalanced,and medical expenses are increasing fast.With these disadvant ages,it is difficult to ensure medical quality.Hence,China is making efforts to protect the rights and interests of the three parties by medical insurance.This paper summarizes the characteristics of the main payment modes(such as payment by items,capitation,service unit and disease type)in China and puts forward suggestions to solve the current predicament of payment modes,trying to provide theoretical basis for the promotion of multiple and compound medical insurance payment modes.