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Point总额控制是目前医保部门普遍采取的费控管理措施,是基于医疗费用快速增长以及医保基金收支平衡考虑下的一种选择。各医保经办机构按照医保基金“以收定支、收支平衡、略有结余”的原则,在医保基金总量控制基础上,对所辖定点医疗机构制定详细而具体的资金分配及监管方案。因此,对异地就医人员所发生的医疗费用的各项指标可以参照就医地总额控制的标准进行管控是必然的。但是,若纳入总额控制不尽合理,也不便于管理。
Point total control is the common cost management measures taken by the health insurance sector. It is an option based on the rapid growth of medical expenses and the balance of payments of medical insurance funds. The medical insurance agencies in accordance with the principle of the Medicare Fund “to receive payments, break even, a slight balance ” principle, based on the total amount of medical insurance fund control, the designated medical institutions under the jurisdiction of the development of detailed and specific funding allocation and Regulatory program. Therefore, it is inevitable that various indicators of medical expenses incurred by medical staff in different places can be controlled according to the standard of total amount of medical treatment. However, if the total amount of control is not reasonable, it is not easy to manage.