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杭州医保付费总额控制引入预决算管理思路,以上年该医药机构有效服务产生的医疗费为基数,结合医疗服务利用量可容许的上涨率确定为本年医疗费预算基数。年初下达预算指标,按月拨付,年终决算。主要特点有,(1)实现三个全覆盖,即各类参保人员在所有定点医药机构发生的全部就医购药费用均纳入管理范围。(2)管理总医疗费,将符合医保支付范围的总医疗费作为管理
The total amount of medical insurance control in Hangzhou introduced the management principle of the budget of final accounts. Based on the medical expenses generated by the effective service of the medical institutions in the previous year, the allowable rising rate of medical service utilization was determined as the base of the medical expenses budget for the year. Budget indicators issued at the beginning of the month, to be paid on a monthly basis. The main features are: (1) to achieve three full coverage, that is, all types of insured persons in all designated medical institutions occurred in all medical expenses are included in the management of medical expenses. (2) To manage the total medical expenses, and manage the total medical expenses in line with the coverage of medical insurance