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如何在有效控制不合理医保费用支出,确保基金良性运行,最大限度发挥基金使用效率的同时,又能引导医疗机构不断提高服务质量和水平,更好地满足参保患者的医疗需求,是医保制度改革研究和实践的重点。笔者认为在医保费用结算过程中,只有始终体现“一切以病人为中心,资金跟着病人走”的费用偿付理念,依据真实、有效的服务量“就诊人头”对医疗机构费用考核与偿付,才能较好地解决医保费用控制与医疗服务质量这一对矛盾。
How to effectively control unreasonable medical insurance expenses, ensure the benign operation of the fund, maximize the efficiency of fund utilization, and at the same time guide the medical institutions to continuously improve the service quality and level so as to better meet the medical needs of insured patients. Reform the focus of research and practice. The author believes that in the medical insurance fee settlement process, only always reflects the “all patient-centered, funds follow the patient to go” fee reimbursement concept, based on real and effective service " In order to solve the contradiction between medical insurance cost control and medical service quality better,