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国外门诊医疗保障保什么

         

摘要

Generally the outpatient services are covered by the social health insurance systems in most developed countries. Outpatient benefit catalogues are defined and regulated through legislations passed by central or regional governments decrees issued by national or regional governments directives issued by self-governing bodies or by national and/or local authorities and other documents considered as“quasi-laws”. The structure of outpatient benefit catalogues is very similar in most developed countries. Except few explicitly excluded services, most outpatient services are fully or partly funded by the public funds. And they usually reimbursed by fixed budget capitations or fee-for-service. The value orientation behind the outpatient benefit catalogues is“fairness”and“health care right”maybe it is the most important thing for China in the process of establishing China’s outpatient co-ordinate system.%  发达国家的社会医疗保险制度发展成熟之后,一般都会覆盖门诊医疗服务。门诊医疗保障的项目和待遇水平通常以国家各级法律法规的形式予以确定。各国门诊待遇目录的结构大致相似,除了少数明确排除的项目,大多数门诊医疗服务都能全部或部分地得到公共基金的补偿,补偿的方式主要是总额预付或按人头付费和按服务项目付费。发达国家门诊保障背后体现出明显的强调“公平”和“医疗享有权”的价值取向,这对于构建中国门诊统筹制度具有启示和借鉴意义。

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