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医疗保险好比一个蓄水池,基金筹集是入水口,付费是出水口,出水口的大小合适与否直接关系到蓄水池的蓄水能力。国内外医疗保险制度改革的实践无不表明,付费方式的改革和完善是控制医疗保险费用支出的最有效的办法。医疗保险付费方式通过对医疗机构(以下简称供方)和参保人(以下简称被保险方)行为的监督、控制,使基本医疗服务消费保持为当地适当的水平,从而有效地使用有限的医疗保险基金,确保医疗保险基金的抗风险能力。如何制订适当的付费方式,从而在供方、被保险方、医疗保险管理部门三方之间形成有效的利益约束机制,既调动供方的积极性,又合理使用医疗费用,的确是一个值得深入探讨的问题。
Medical insurance is like a reservoir, fund raising is the water inlet, pay is the outlet, the outlet size is directly related to the reservoir’s water storage capacity. The practice of the reform of the medical insurance system at home and abroad all shows that the reform and improvement of the payment method is the most effective way to control the expenditure on medical insurance. Medical insurance payment method By monitoring and controlling the behavior of medical institutions (hereinafter referred to as providers) and insured persons (hereinafter referred to as insured parties), the consumption of essential medical services is maintained at a suitable local level to effectively use limited medical services Insurance funds to ensure that the medical insurance fund anti-risk ability. How to formulate an appropriate payment method so as to form an effective interest restraint mechanism among the supplier, the insured and the medical insurance administration will not only mobilize the enthusiasm of the supplier but also make reasonable use of the medical expenses, which is indeed worthy of further discussion problem.