农村地区以住院服务纵向整合为导向的医保支付方式设计

The Design Method of Medical Insurance Payment Oriented by Vertical Integration of Inpatient Services in Rural Areas

增强县乡两级医疗机构分工协作,实现县乡两级医疗机构的功能互补和服务连续,对于农村地区分级有序就医格局的形成至关重要。以此为目标,提出了县乡跨机构按病种支付方式,并从病种选择、连续性服务路径、支付标准、分配方案等方面进行了设计,从机构收益、患者自付、医保支出等方面对其潜在效果进行了分析。

Strengthening the cooperation,and realizing the functional complementation and continuous service of medical institutions at county and township levels between medical institutions at county and township levels are crucial to tiered medical services in rural areas.It proposed the payment by disease for services between county and township medical institutions.The aspects of disease type selection,continuous service path,and payment standard and distribution scheme are designed to analyze its potential effects from the aspects of institutional income,out of pocket expenses,and health insurance expenditure.