总额控制之下的医保付费方式改革

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目前,我国基本确立了总额控制下的多种付费方式综合运用的支付制度构架。总额控制作为支付制度的基础,其建立是付费方式改革的开始,任重道远。从国际医保付费方式演变看,从后付向预付制转变是公认的发展趋势,也是我国医保付费方式改革的方向。准确把握预付与后付的本质区别,认识预付制所传递的核心理念,明晰各种付费方式演变的内在动因及其支撑条件,是寻找适合我国国情的付费方式组合,正确把握付费方式改革节奏的前提。 At present, our country has basically established the payment system framework for the comprehensive utilization of various payment methods under the total amount control. As the basis of the payment system, the establishment of total control is the beginning of reform of the payment method and there is a long way to go. From the evolution of the international medical insurance payment system, the change from post-payment to prepaid system is a recognized development trend and also the direction of the reform of medical insurance payment in China. Accurately grasp the essential differences between prepaid and postpay, understand the core concepts passed by prepaid system, clarify the intrinsic motivation and supporting conditions for the evolution of various payment methods, and find a combination of payment methods suitable for China’s national conditions and correctly grasp the reform of payment methods premise.
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