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目前国内外常见的医疗保险费用偿什模式大体上分为“预付”和“后付”两类。其主要包括按服务项目偿付、按人头预付、按病种偿付、按住院天数偿付、及按每门诊人次偿付几种模式。一旦费用偿付模式确定后,保险人、被保险人分摊费用有;扣除法、共付法、限额法或最高额法、扣除法与共什法结合法。本文所述医疗保险费用偿付模式及费用分摊形式旨在探讨各种模式的适用范围与条件,寻求适应深圳市医疗保险费用偿付模式。
At present, common modes of paying for medical insurance at home and abroad are generally divided into two categories: “prepaid” and “post-pay”. It mainly includes reimbursement by services, payment by head, reimbursement by illness, reimbursement by hospitalization days and reimbursements by clinic. Once the fee reimbursement model is determined, the insurer, the insured person to share the cost; deduction, co-payment law, the ceiling or the maximum amount of law, deduction and the law combined with law. The medical insurance fee reimbursement mode and cost allocation mode described in this paper aims to explore the scope and conditions of various modes of application and seek to adapt to Shenzhen medical insurance fee reimbursement mode.