论文部分内容阅读
定额结算模式又被称平均费用支付或按服务单元支付,即医保部门根据以往历史数据分别与定点医院定额支付标准协议,并根据固定时间段内医院实际均次费用与定额标准进行结算。当实际平均费用低于定额标准时,按实际发生额结算,当实际平均费用高于定额标准时,则先按定额结算,对于超出部分,按比例分担。
The fixed settlement model is also called the average cost or paid by the service unit, that is, the medical insurance department separately negotiates with the fixed hospital fixed payment standard according to the historical data and settles according to the actual average hospital charges and the fixed standard within a fixed period of time. When the actual average cost is lower than the fixed standard, the settlement shall be made according to the actual amount. When the actual average cost is higher than the fixed standard, the fixed amount will be settled first, and the excess part will be shared on a pro rata basis.