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医保费用结算方式在医疗保险制度中具有重要的杠杆作用和主导地位,是医疗保险制度的关键系统之一。结算方式的合理性直接决定了医疗保险制度的效果,也决定了医疗卫生服务的供方—医院的改革与发展方向[1]。龙岩市于2001年1月起正式实施城镇职工基本医疗保险制度改革,实行按住院人头付费与部分专科疾病按病种付费相结合的支付方式,有效地控制了医保统筹基金的浪费,较好地运用经济杠杆的作用规范了医院的医疗服务,发挥了结算方式在医保管理中的作用,使医院的各项工作在医保和医改的进程中保持蓬勃发展。
The settlement method of medical insurance costs has an important leverage and dominant position in the medical insurance system and is one of the key systems of the medical insurance system. The rationality of the settlement method directly determines the effectiveness of the medical insurance system, and also determines the direction of the supplier-hospital reform and development of medical and health services [1]. In January 2001, Longyan City officially implemented the reform of the basic medical insurance system for urban employees, and implemented a payment method that combined hospitalization of head-to-head payments with the payment of disease-specific payments for some specialist diseases, effectively controlling the waste of the medical insurance pool, and better The role of economic leverage was used to standardize the hospital’s medical services, and the role of settlement methods in the management of medical insurance was brought into full play, so that the hospital’s various tasks were maintained vigorously in the process of medical insurance and medical reform.