医疗保险机构与定点医疗机构的医疗费结算是职工医疗保险结算办法的核心,结算费用约占整个基金的70%以上。结算办法是联系医疗保险基金的安全营运、职工的基本医疗保障及医疗机构的经济利益三者之间的纽带,在医疗保险学领域是一个重要课题,具有很强的科学性和实践性。一、制定结算办法必须以成熟的结算模式为基础。在医改之初,制定结算办法时必须吸收别人的经验和研究 Medical insurance agencies and medical institutions set-point medical bills settlement is the core of the medical insurance settlement, the settlement costs account for about 70% of the entire fund. The settlement method is a link between the safe operation of medical insurance funds, the basic medical insurance for workers and the economic interests of medical institutions. It is an important issue in the field of medical insurance and has strong scientific and practical characteristics. First, the establishment of a settlement method must be based on a mature settlement model. At the beginning of the medical reform, we must absorb other people’s experience and research when formulating the settlement method