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医疗保险费用结算模式是指医疗保险费用拨付的途径和方法。医疗保险不同的结算模式形成医疗服务供给者、医疗服务需求者及医保基金经营者之间不同的制约关系,反映医疗保险不同的保障程度、经济后果和资源流向。合理的结算模式可以调节被保险人的医疗需求,影响医疗服务提供者的行为,保证医保基金得到充分有效利用,同时对全社会医疗卫生资源的合理配
Medical insurance fee settlement mode refers to the way and method of medical insurance expenses. The different settlement modes of medical insurance form different restrictive relationships among medical service providers, medical service demanders and medical insurance fund managers, and reflect different levels of medical insurance coverage, economic consequences and resource flows. Reasonable settlement mode can adjust the medical needs of the insured, affecting the behavior of medical service providers to ensure full and effective use of medical insurance funds, at the same time, the reasonable allocation of resources for health care in the whole society