宿迁市城镇医保按病种分值付费绩效分析.pdfVIP

………. I I I I @ 管理平台 宿迁市城镇医保 按病神分值付费绩效分析 李涛袁振 (江苏省宿迁市社会保险基金管理中心宿迁 223800 ) 【 摘要】 宿迁市学习借鉴淮安经验组织实施的按病种分位付费，使医疗费用得到合理控制，医保基金收 入、支出、给余实现三增加\基金绩效明显提升，新医改提出的让老百姓看得起病的目标圆满实现。 宿迁的实践再次证明，按病种分位付费对于落实总额控制目标、发挥基本医保对医疗服务的激励约束作用等 效果凸显。 【 关键词 】 支付制度改革;按病种分依付费;实施效采 【 中图分类号】 F840.684 C913.7 【文献标识码】 A 【文章编号] 1674-3830 (2016) 8-46-4 doi:l0.369/j.iss n .1674-3830.2016.8.011 Allalysis on the Pelformance of U.ball Medical Illsurance Paymellt by Disease-sω.es ill @ Suqiall Li Tao,Yuan Zhen(Jiangsu Human Resources Social Security Bureau, Suqian,223800) @ [ Abstract] By leaming the experience of insmance payment by disease-scores from Huaian, the medical expenses of Suqian has been reasonably contI咀led; the medical insurance fund collecting, expenditure and balance have achieved the goal of three-increases; the pelfOlmance of insurance fund has been significantly enhanced; and the aims of affordable medical care proposed by the new medical system refolm has been fully achieved. The practice in Suqian once again proved that the payment by disease-scores has prominent effects on the implementation of total budget conn叫and makes basic health insmance playing incentive and restraint roles in medical services . [ Key words ] pa严nent system refolm , according to the score of the disease, implementation effect 1 医保支付制度改革概况 盖后，更应该顺势而为，在转变医保 付费转变为按病种分值付费是医保 宿迁市自2000年建立职工基本 发展方式上下功夫，从外延扩张向 经!h、机构与医疗机构之间的基金结 医保制度，到2012年主要实行按项 提升医疗保险医疗服务质量和基金 算方式改革，