论文部分内容阅读
随着我国医保体系的不断健全,医保总额支付制度改革也日益成为人们关注的焦点,全国范围内多个省市已推行了总额支付制度。2012年人社部发布了《关于开展基本医疗保险付费总额控制的意见》,广州市于2014年7月出台了《广州市社会医疗保险医疗费用结算办法》,明确规定在全市施行总额控制办法。本文调取广州某三甲医院2012—2014社保年度城镇职工医保数据,回顾分析在平均费用定(限)额结算办法下有关指标运行情况,为医院有效应对总额支付制度改革,确保医院健康发展提出建议。
With the continuous improvement of the medical insurance system in our country, the reform of the total medical insurance payment system has also become the focus of people’s attention day by day. In many provinces and cities across the country, the total payment system has been implemented. In 2012, the Ministry of Human Resources and Social Security released the Opinions on Controlling the Total Payment of Basic Medical Insurance. Guangzhou Municipality issued the “Measures on Settlement of Medical Expenses for Social Medical Insurance in Guangzhou City” in July 2014, which clearly stipulates that the total amount control measures should be implemented throughout the city. This paper retrieves the health insurance data of urban workers in 2012-2014 Social Security Annual for a top-three hospital in Guangzhou and reviews the operation of the indicators under the settlement method of the average fee (limit), and provides suggestions for the effective reform of the hospital’s total payable payment system to ensure the healthy development of the hospital .