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关注医保支付方式改革:按病种付费为主 多元复合式支付

2017-06-30 佚名 央视网

近日,国务院办公厅印发《关于进一步深化基本医疗保险支付方式改革的指导意见》,对下一步全面推进医保支付方式改革做出部署。

近日,国务院办公厅印发《关于进一步深化基本医疗保险支付方式改革的指导意见》(以下简称《意见》),对下一步全面推进医保支付方式改革做出部署。

《意见》要求,2017年起,进一步加强医保基金预算管理,全面推行以按病种付费为主的多元复合式医保支付方式。到2020年,医保支付方式改革覆盖所有医疗机构及医疗服务,按项目付费占比明显下降。

《意见》指出,医保支付是基本医保管理和深化医改的重要环节,是调节医疗服务行为、引导医疗资源配置的重要杠杆。新一轮医改以来,各地积极探索医保支付方式改革,在保障参保人员权益、控制医保基金不合理支出等方面取得积极成效,但医保对医疗服务供需双方特别是对供方的引导制约作用尚未得到有效发挥。为更好地保障参保人员权益、规范医疗服务行为、控制医疗费用不合理增长,充分发挥医保在医改中的基础性作用,需要进一步深化基本医疗保险支付方式改革。

《意见》提出,要针对不同医疗服务特点,推进医保支付方式分类改革。对住院医疗服务,主要按病种、按疾病诊断相关分组付费,长期、慢性病住院医疗服务可按床日付费;对基层医疗服务,可按人头付费,积极探索将按人头付费与慢性病管理相结合;对不宜打包付费的复杂病例和门诊费用,可按项目付费;探索符合中医药服务特点的支付方式。要强化医保对医疗行为的监管,将监管重点从医疗费用控制转向医疗费用和医疗质量双控制。

《意见》要求各地结合医保基金预算管理,完善总额控制,积极探索将点数法与预算管理、按病种付费等结合应用。严格规范基本医保责任边界,重点体现“保基本”,公共卫生费用、体育健身或养生保健消费等不得纳入医保支付范围。通过对符合规定的转诊住院患者连续计算起付线,将符合规定的家庭医生签约服务费纳入医保支付范围,探索对纵向合作的医疗联合体等分工协作模式实行医保总额付费等措施,引导基层首诊、双向转诊。建立区域内医疗卫生资源总量、医疗费用总量宏观调控机制,控制医疗费用过快增长。推行临床路径管理和医学检查检验结果互认,完善公立医院绩效考核和收入分配机制,规范和推动医务人员多点执业。

《意见》强调,要充分认识深化医保支付方式改革的重要性,促进医疗服务行为规范,调动医疗机构和医务人员主动控制医疗成本的积极性,支持建立分级诊疗模式和基层医疗卫生机构健康发展,切实保障广大参保人员基本医疗权益和医保制度长期可持续发展,为医疗卫生体制改革的深化提供助力。

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医保支付:国家改革方案来了!披露6大焦点

11月23日,悬而未决的医保支付标准制定正式结束意见征求,进入文件出台的冲刺阶段。即便按照今日微信流传的最终12月公布这一时间点,也已经较原计划2015年9月31日前完成医保支付标准制定的期限,整整晚了近14个月。而对各省来说更为紧迫的是——按照文件要求,在2016年完成各地支付标准制定的具体实施方案,仅余最后40天。根据今日微信流传的征求意见稿内容,赛柏蓝将即将出台的医保支付六大核心问题整理如下

谈谈医保控费:管理部门须与医院同心同向同力

目前比较合适的就是“以按病种付费为主”的多种支付方式并存的复合性付费模式,逐步过渡到DRGs付费模式,这也是国家医保支付制度改革的方向。

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