我国医保“点数法”的实践及思考
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摘要
当前我国越来越多的地区在医疗保险付费方式改革中引入"点数法"。以我国台湾地区、金华市、东营市、淮安市、银川市等地为例,分析我国医保"点数法"实践中取得的医保基金预算分配相对公平、医保资金使用效率大大提升、基金风险可控、配套绩效考核措施不断完善等成果;同时指出存在登记系数难以确定、医保机构监管力度弱、存在医疗服务质量下降风险等问题,提出应设计一套能够准确计算等级系数的数学模型、加强医疗总费用监控、加强医疗质量监管等改进建议,以促进医保制度改革的深化。
At present,more and more areas in China introduce"Points Method"in the reform of medical insurance payment method. The writer takes Taiwan,Jinhua,Dongyin,Huaian,Yinchuan and so on as examples,analyzes the achievement of relative equity in medical insurance fund budget allocation,greatly promote medical insurance fund usage efficiency,controlled fund risk,continuously perfect mating performance assessment measure and so on in practice of medical insurance"Points Method". Meanwhile,it points out problems such as that register coefficient is difficult to determine,supervision dynamics of medical insurance agency is weak,existing the risk of medical service quality decline and so on. It puts forward that we should design a set of mathematical model to be able to accurately calculate grade coefficient,strengthen medical service total expense and medical quality supervision,so as to promote deepen of medical insurance system.
At present,more and more areas in China introduce"Points Method"in the reform of medical insurance payment method. The writer takes Taiwan,Jinhua,Dongyin,Huaian,Yinchuan and so on as examples,analyzes the achievement of relative equity in medical insurance fund budget allocation,greatly promote medical insurance fund usage efficiency,controlled fund risk,continuously perfect mating performance assessment measure and so on in practice of medical insurance"Points Method". Meanwhile,it points out problems such as that register coefficient is difficult to determine,supervision dynamics of medical insurance agency is weak,existing the risk of medical service quality decline and so on. It puts forward that we should design a set of mathematical model to be able to accurately calculate grade coefficient,strengthen medical service total expense and medical quality supervision,so as to promote deepen of medical insurance system.
引文
[1]于保荣. DRGs按病种支付与点数法支付[J].中国卫生,2018,(5):44.
[2] HENDRIK S. Practice Budgets and the Patient Mix of Physicians-The Effect of A Remuneration System Reform on Health Care Utilization[J]. Journal of Health Economics,2013,32(6):1240-1249.
[3] MARKUS W,REINHARD B. Analising the Impact of Healthcare System Change in the EU Member States-Germany[J].Health Economics,2005,14(1):133-149.
[4]刘芳,赵斌.德国医保点数法的运行机制及启示[J].德国研究,2016,31(4):48-63,145-146.
[5]曹凯.金华医保支付“病组点数法”盘点[J].中国医院院长,2018,(3):21.
[6]邵宁军,严欣.金华医保“病组点数法”付费改革成效评析[J].中国医疗保险,2018,(4):41-43.
[7]赵斌.点数法地方实践的比较[J].中国社会保障,2017,(3):75-77.
[8]叶龙杰.“点数法”让医保总额控制更精准[N].健康报,2017-10-24(003).
[9]林枫.点数法—居民医保费用支付的另一种选择[J].中国社会保障,2007,(5):48-49.
[10]张兴.“点数法”中的医疗机构等级系数[N].中国劳动保障报,2017-07-18(004).
[11]张兴.点数法面临几重难题[J].中国社会保障,2017,(3):78-79.
[12]王宗凡.如何完善“点数法”总额控制[J].中国社会保障,2017,(3):80-81.
[13]张晓东.预算管理:点数法引领支付方式改革[N].健康报,2018-05-08(005).
[2] HENDRIK S. Practice Budgets and the Patient Mix of Physicians-The Effect of A Remuneration System Reform on Health Care Utilization[J]. Journal of Health Economics,2013,32(6):1240-1249.
[3] MARKUS W,REINHARD B. Analising the Impact of Healthcare System Change in the EU Member States-Germany[J].Health Economics,2005,14(1):133-149.
[4]刘芳,赵斌.德国医保点数法的运行机制及启示[J].德国研究,2016,31(4):48-63,145-146.
[5]曹凯.金华医保支付“病组点数法”盘点[J].中国医院院长,2018,(3):21.
[6]邵宁军,严欣.金华医保“病组点数法”付费改革成效评析[J].中国医疗保险,2018,(4):41-43.
[7]赵斌.点数法地方实践的比较[J].中国社会保障,2017,(3):75-77.
[8]叶龙杰.“点数法”让医保总额控制更精准[N].健康报,2017-10-24(003).
[9]林枫.点数法—居民医保费用支付的另一种选择[J].中国社会保障,2007,(5):48-49.
[10]张兴.“点数法”中的医疗机构等级系数[N].中国劳动保障报,2017-07-18(004).
[11]张兴.点数法面临几重难题[J].中国社会保障,2017,(3):78-79.
[12]王宗凡.如何完善“点数法”总额控制[J].中国社会保障,2017,(3):80-81.
[13]张晓东.预算管理:点数法引领支付方式改革[N].健康报,2018-05-08(005).