Total value prepays and pays the mainstream as medical insurance

Total value prepays and pays the mainstream as medical insurance
The human resources and social security department released " suggetion on further advancing the reform of way of paying of the medical insurance " a few days ago, the task goal of putting forward and advancing the reform of way of paying of the medical insurance at present is: Combine the revenue and expenditure budget management of funds and strengthen total value to control, explore total value is prepaid; On this basis, combine pool of clinic and explore that pays according to the number of people, combine in hospital serious disease of clinic ensures exploring that pay according to number.
It is reported, it is a medical insurance department after evaluating medical organization that the total value of medical insurance is prepaid and made, calculate the per capita hospitalization cost, prepay the medical fee of the quota to the hospital according to this expense standard, take place actually expenses overspend, overspend part undertake by the intersection of hospital and oneself. At present, most areas of our country adopt the means of payment paid according to the service item. Compared with the current means of payment of medical insurance, total value has prepaid and strengthened behavioral control to medical treatment, can prevent the medical organization from making great prescription, checks arbitrarily, arbitrary charge, expanding drawbacks such as the service item,etc. arbitrarily effectively. At present, Shanghai, Beijing and other places has already explored correspondingly.
" opinion " requires, all parts confirm according to the gross expenditure of the fund that controls the index to every total value of way of paying, according to different fixed rank, classification, characteristic and factor of service amount,etc. born of medical organization, implement to every fixed medical organization, and every settlement cycle, and reflect in the medical insurance handles the agreements of organization and fixed medical organization. Medical insurance handle organization according to agreement, on time full-amount to pay expense to the fixed medical organization. Meanwhile, according to fund ability and settlement cycle, define that sets aside the fixed condition of revolving fund of medical organization and amount of money in advance.
" opinion " is required, must define the basic medical care of pool of clinic is chartered while paying according to the number of people, ensure, effect an insurance the intersection of personnel and basic the intersection of medical insurance and class-A medicines, make a diagnosis fee and other essential at the basic level the intersection of medical care and payment of expense generally at first. Pay and can start from single number according to number, the intersection of prior choice and clinical the intersection of route and clear, complication and amalgamate disease to be little making a diagnosis the intersection of technology and ripe, the intersection of quality and controlled and the intersection of expenses and steady common disease, frequently-occurring disease. Meanwhile, giving consideration to children's leukemia, congenital heart disease has disease of great social influence to wait at present. Wouldn't possess and implement it according to the number of people or according to the place that number pays, as transition way, can a current until the intersection of project and way of paying change total value into control one according to average the intersection of quota and way of paying.
|