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新农村合作医疗制度在运行中因医疗费用过快增长和基金被过度消耗而影响其健康运行,而支付制度是控制医疗费用增长的关键,支付制度的缺陷直接影响“新农合”健康运行。在国外行之有效的付费制度,在中国农村的实践中遭遇了严峻的挑战。文章在支付制度本身和政策、法律环境等实施环境方面分析缺陷产生的原因,借鉴美、德、日及巴西、泰国的农村医疗保险实施的成功经验,提出选择引入昏迷分级、DRGs、病人管理分组等辅助度量工具的按人/次门诊支付和按服务项目支付、有起付线和封顶线、固定自负比例相结合住院支付的混合型支付制度的建议,并在法律和政策上相应完善。
The new rural cooperative medical system is in operation due to excessive growth of medical costs and over-consumption of funds to affect its healthy operation. The payment system is the key to controlling the growth of medical expenses. The defects of the payment system have a direct impact on the health of run. The effective payment system abroad has encountered severe challenges in the practice of rural China. Based on the successful experience of the implementation of rural medical insurance in the United States, Germany, Japan and Brazil and Thailand, the article proposes the introduction of coma classification, DRGs, patient management grouping And other supplementary measurement tools pay per patient / outpatient service and pay by service line, with a payline and a cap line, a fixed proportion of self-pay combined hospital payment of hybrid payment system recommendations, and the corresponding legal and policy improvements.