住院医疗费用总额预付制结算办法及其运行效果评价.pdfVIP

-医疗保障· 住院医疗费用总额预付制结算办法及其运行效果评价 姜 丽·张开金黄新王进 东南大学公共卫生学院 江苏南京210009 【摘要】近年来，我国医疗费用快速增长，其中住院医疗费用的增长更快。随着新医改的推进，各地都在 积极探索医疗费用的控制方法。江苏省w市医疗保险基金管理中心制定了住院费用总额预付标准，对医疗 保险定点医疗机构的年度住院费用进行总额控制，对定点医院参保人员住院费用实行“总额控制、按月结付、 超支分担、节余留成”的结算办法。该办法对控制住院医疗费用的快速增长，减轻参保人的医疗费用负担起到 了积极的作用。在详细调查了W市定点医疗机构住院医疗费用预付总额制定办法的基础上，对其合理性、存 在问题以及运行效果进行了评价，并提出了完善这一办法的建议。 【关键词】医疗保险；定点医疗机构；住院医疗费用；总额预付 中图分类号：R197文献标识码：A doi：10．3969／j．issn．1674-2982．2010．06．009 oftotal Settlementmethod andits evaluationfor prepaid operation inpatientexpenditure JIANG Xin，WANGJin Li，ZHANGKai-jin，HUANG SchoolPubic of Health，SoutheastUniversity，JiangsuNanjing210009，China recent costs evenmore 【Abstract】Inyears，medicalrisingfast，whichinpatient expenditurerising seriously． Withthe ofnewhealth to controlmedicalcosts progresses reform，manyplacesexplorewaysactively medicalinsurancefund in of the of centerW Province standardstotal management City developed Jiangsu prepaid costsfor to its at controlannual costs．The fortheinsured the designated inpatient hospital inpatientexpenses person wasusedthesettlement of“total statementto oveiTuns—sha— designatedhospital approach control，amonthly pay，cost retained”．This rolein ring，saving anactive the of costs，which approachplayed contr