天长市县域医共体内医保预付制对医疗费用控制研究

摘要

Objective To explore the control of medical expenses under the total capitation payment system in the mode of medical alliance.Methods Through the use of medical insurance theory of medical expenses control theoryfrom the provider payment,risk sharing,provider competition,cost responsibility restraint,and incentive supervision and management,analysis of the changes of medical expenses due to the integration of the medical and insurance payment reform in Tianchang City,Anhui Province was done.Resets After the reform of prepaid medical insurance system reform of medical alliance in Tianchang City,the county town visit rate increases,medical costs have been further controlled,and the actual medicare reimbursement ratio increases.Conclsion The linkage reform of medical system and medical insurance payment mode is conducive to the control of medical expenses.%目的 探究在医共体模式下医保预付制对医疗费用的控制和作用途径.方法 运用医疗保险理论中医疗费用控制理论,从提供者支付、风险分担、提供者竞争、费用责任约束和激励、监督和管理等方面,分析安徽省天长市可能由于医共体内医保支付方式改革引起医疗费用变化的原因.结果 天长市医共体内医保预付制改革后,县域内就诊率提高,医疗费用得到进一步控制,医保实际报销比增高.结论 医疗与医保联动改革有利于医疗费用的控制.