紧密型医联体总额付费的探索和建议

The Consideration and Suggestion of the Total Payment of Intensive Medical Association

目的:对典型的紧密型医联体总额付费的特点和存在的主要问题进行分析梳理。方法:通过实地调研、专家访谈、查阅相关政策文件或信息,对5省7市的紧密型医联体的医保支付进行了比较分析和SWOT分析;通过对医疗机构医保从业人员的调查问卷。结果:对紧密型医联体实行总额付费,在总额预算、结余分配和精细化管理方面还存在不同认识和操作不一的情况。结论:紧密型医联体总额付费,关键要科学预算总额,充分理解支付方式改革和总额预算的关系、建立医保管理部门与医疗机构的磋商和培训机制和相应配套制度要跟上,信息互联互通等。

Objective:To analyze and sort out the characteristics and main problems of the total payment of the typical compact medical association.Methods:Through field investigation,expert interview,relevant policy documents or information,comparative analysis and SWOT analysis were made on the medical insurance payment of the compact medical association in 7 cities of 5 provinces.In addition,a questionnaire was made for medical insurance practitioners in medical institutions.Results:Total payment was applied to the compact medical association,but there were still different understandings and operations in terms of total budget,balance allocation and fine management.Conclusion:The key to total payment in close medical associations is to budget the total amount scientifically,fully understand the relationship between payment reform and total budget,establish consultation and training mechanisms between health insurance management and medical institutions and corresponding supporting systems to keep up,and interconnect information,etc.