我国总额预付实施现状及存在问题探讨

摘要

在界定总额预付的概念和内涵、梳理我国总额预付历史沿革和实施现状的基础上，重点分析了我国总额预付实施中存在的问题，包括：预算总额的制定与调整机制不完善，结算方式不成熟，监管机制尚未形成以及与其他支付方式改革结合不紧密等。进而提出了政策建议：参保人群定点化管理和探索区域性集团化总额预付模式，科学化测算和调整总额，合理确定结算标准和规则，加强监督和考核，以及在总额预付框架下开展多种支付方式改革等。%Based on a definition of the concept and its connotation,and summary of the evolution and practice of global budget in China,this paper focused on analyzing the existing problems,namely a defective mechanism in the determination and adj ustment of the total budget,unreasonable settlement, absence of a regulatory mechanism and poor linkage of this system with other payment modes reform.Thus the authors proposed such policy recommendations as designated management of those covered by health insurance,and experiments with the global budget mode for regional groups,scientific estimation and adj ustment of the total budget,reasonable setting of settlement standards and rules,and enhanced supervision and appraisal,as well as various payment system reforms based on global budget.