“预付制”——医保费用结算方式尝试

• 作 者: 刘阿明
• 出 处: 中国社会保障
• 发表日期: 2001年06期
• 关键词: 预付制 医保费用 治疗费用 账户基金 以收定支 收支平衡 管理目标 结算办法 疾病 基金支付 疗保险 海南省 总额 责任 控制 节余 风险 定额

共济账户基金的管理目标是:“以收定支,收支平衡,略有节余。”要实现这个目标,关键在于使十分有限的基金支付得到有效的控制,量入为出,保证严重疾病的治疗费用,真正承担起疾病风险的社会共济责任。海南省对医疗保险共济支付采用总额定额预付的结算办法,作了一些探索和尝试,取得了较好的效果。

The goal of the mutual fund account management is to “keep balances and balance receipts and expenditures slightly.” The key to achieving this objective is to effectively control very limited fund payments, to ensure that the treatment of serious illnesses , Truly assume the risk of social responsibility. Hainan Province made a series of explorations and attempts to settle the medical insurance payment by adopting the settlement method of total quota and achieved good results.