中国医保支付体系改革25年:成就、问题与展望

25 Years of Reform in China's Medical Insurance Payment System:Achievements,Problems,and Prospects

医保支付体系和支付机制是决定医保制度运行和医保基金支付的核心规则,是关系到群众医疗服务的获得感和医保基金使用效率的关键所在。本文对我国建立基本医疗保险制度25年以来支付方式改革取得的成就进行了总结,对支付方式发展历程进行了回顾;在分析医保支付方式改革现状和目前存在的问题基础上,提出中国特色医保支付体系改革未来发展的五个取向,包括从后付制到预付制,从总额控制到总额预算,从西学中用到中西结合,从单一方式到多元复合,从数量支付到价值购买;最后,从联动机制、支付机制、支付政策和支付体系等四个方面对构建统一的中国特色医保支付体系改革前景提出政策建议。

The medical insurance payment system and its mechanisms are critical to the governance of the medical insurance scheme and the allocation of medical insurance funds,signifi cantly impacting insured individuals'access to medical services and the efficient utilization of funds.This paper provides an overview of the achievements in payment reform over the past 25 years since the inception of basic medical insurance in China.It traces the evolution of payment methods during this period and conducts a comprehensive analysis of the current status and prevalent issues in medical insurance payment reform.Additionally,five strategies are proposed for the future development of China's medical insurance payment system reform:transitioning from a post-payment to a pre-payment model,shifting from global control to a global budget approach,incorporating a blend of Chinese and Western elements,adopting a mix of multiple payment methods,and transitioning from quantity-based payment to value-based purchasing.Finally,policy recommendations are offered for prospective reform,emphasizing the establishment of a unified medical insurance payment system with Chinese characteristics,covering aspects such as coordinated mechanisms,payment policies,and the overall system.