定额结算和总额预算管理是从微观和宏观两个方面对定点医疗机构实施制约,是促使他们对待医改的态度从被动应付向主动介入转变的手段,但在实际管理过程中如何操作则有一个实践、探索、完善的过程。 一、定额结算 定额结算是按平均费用标准,对定点医疗机构偿付医疗保险费用的方式之一,平均费用标准一般以医改前三年实际发生值再加上物价上涨指数、自然增长率等因素综合而成的。对职工医疗保险基金管理中心(以下简称基金中心)来说,确定了平均费 Quota settlement and total budget management are the means of restricting the fixed medical institutions from the microscopic and macroscopic perspectives. They are the means to change their attitudes toward medical reform from passive coping to active intervention. However, there is a practice of how to operate in the actual management process , Explore, improve the process. I. Quota Settlement Quota settlement is one of the ways to pay the medical insurance fee by designated medical institutions according to the average cost standard. The average cost standard is generally based on the actual value of the three years before the medical reform plus the price inflation index and the natural growth rate Made of For the employee medical insurance fund management center (hereinafter referred to as the fund center), the average fee