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.
引文
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