镇江、九江、青岛三市城镇职工基本医疗保险医疗费用结算方式的比较研究.pdfVIP

( ) 【医疗市场】 中国卫生事业管理 　2009 年第 9 期 总第 255 期 镇江 、九江 、青岛三市城镇职工基本医疗保险 医疗费用结算方式的比较研究 孟 　开 ,常文虎 ,张迎媛 , 田　慧 (首都医科大学卫生管理和教育学院 ,北京 100069) 　　[摘要] 　医疗费用结算方式既是控制医疗费用的有效手段 ,也是影响医、保 、患三者之间关系的重要因素 。本研究 通过比较研究镇江 、九江和青岛3 城市医疗费用结算方式的发展过程及存在的问题 , 旨在总结经验 ,为我国制定科学合 理的医疗费用结算方式提供参考依据 。结果显示 :3 城市的医疗费用结算方式都经历了从按服务单元定额结算到总量 控制 、超支不补 ,最后到总量控制 、弹性结算这一过程 。 　　[ 关键词] 　城镇职工基本医疗保险 ;医疗费用结算方式 ( ) 　　[ 中图分类号] 　R 1971 　　　[文献标识码] 　A 　　　[文章编号] 2009 09 - 605 - 04 　　Comparative Study on the Medical Expenses Payment of Urban Employees’Health Insurance among Zhenjiang , Jiujiang and Qingdao CityMeng Kai , et alThe Chinese Health Service Management 　　Abstract 　The way of medical expenses payment can not only control medical expenses , but also influence the relationship among the hospital , insurance company and patient Medical expenses payment of urban employees ’health insurance in Zhenjiang , Jiujiang and Qingdao city were comparatively studied to summarize their experiences and provide valuable reference to develop health insurance system The results show that payment has gone through the same process , which is from service unit payment to global budget with no paying overspend , and finally to global budget with flexible payment 　　Author ’s address 　School of Health Management and Education , Capital Medical University , Beijing , PRChina 　　Key words 　Urban Employees’Health Insurance ; Medical Expenses Payment ( ( ) 　　在我国实施的城镇职