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目的:为控制医疗费用,改变支付方式,探讨总额预算下不同的测算方法和医保方案的设计。方法:在对银川市职工基本医保2012年总额预算描述性分析的基础上,采用比较分析的方法。结果:3种测算中,方法三考虑了医院的综合考评、需求释放、物价增长指数和住院次均费用等系数,比较符合实际运行情况。文章同时还探讨了总额预算过程中如何按照主要收入病种和主要业务量病种进行结构控制。建议:科学合理测算总预算额和各医院分配额;在总额预算基础上必须配合合理的结构控制机制。
OBJECTIVE: In order to control the medical expenses and change the payment method, we discuss the different measurement methods and the design of the medical insurance scheme under the total budget. Methods: On the basis of descriptive analysis of 2012 basic budget of Yinchuan City staff, a comparative analysis method was used. Results: In the three kinds of measurement, the third method considered the hospital comprehensive evaluation, demand release, price growth index and hospitalization cost and other coefficients, more in line with the actual operation. At the same time, the article also discusses how to control the structure of the total budget according to the main income and disease types. Suggestion: Scientifically and rationally estimate the total budget amount and each hospital allocation; on the basis of the total budget, it is necessary to coordinate reasonable structural control mechanisms.