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如果把医疗保险基金比作一个“蓄水池”,那么医疗保险结算方式就是这个蓄水池向医疗机构放水的“阀门”,其设计是否科学合理直接关系到蓄水池中水的节约与浪费,关系到医疗保险基金的利用效率,进而关系到整个医改的成败。近年来,各地在医疗保险结算方式方面进行了一些探索,总的看来,现阶段对医疗服务供方采用总额预付制是比较适合我国国情的。
If the Medicare fund is compared to a “reservoir,” then the Medicare settlement is the “valve” in which the reservoir discharges water to the medical facility. Whether its design is scientifically sound or not is directly related to water conservation and waste in the reservoir , Related to the utilization efficiency of medical insurance funds, and thus the success or failure of the entire medical reform. In recent years, various ways have been explored in the area of medical insurance settlement. In general, the total prepayment system for medical service providers at this stage is more suitable for China’s national conditions.