ISSN 1008-2204
CN 11-3979/C

医保支付方式由治病向健康转型先期探讨研究

Transformation of Medical Insurance Payment Model from Disease Treatment to Health PromotionA Preliminary Study

  • 摘要: 为系统讨论医保支付方式改革驱动由治病向健康转型的可能性和实践模式,以目标—发展重点透视矩阵作为分析框架,以慢性病为切入点,基于安徽省医共体慢性病打包支付的案例,探讨中国情境下的以健康为导向的医保支付方式改革的路径和方法。研究发现,伴随人口结构和社会需求的变化,在理念层面上,医保支付政策已体现出由治病向健康转型的态势,医保支付政策的内容、形式、载体趋向多样化。目前中国复合式医保支付框架已经建立,但改革内容和进展不平衡,尚未发挥向健康转型的激励引领作用。持续推进医保支付方式改革并对改革内容进行适应性调整,将是下一阶段工作的重点。

     

    Abstract: To systematically investigate the possibility and practice mode of the transformation of medical insurance payment model from disease treatment to health promotion driven by the reform, this paper uses the Objectives-Keys Perspective Matrix as the analytical framework, takes chronic diseases as the entry point, and explores the paths and methods of health-oriented reform of medical insurance payment model in the Chinese context based on the case of bundled payment for chronic diseases in the Anhui Provincial Medical Consortium. The study finds that with the changes in population structure and social needs, at the conceptual level, medical insurance payment policies have shown a trend of the transformation from treating diseases to promoting health, and their content, form, and carriers are becoming more diverse. Currently, China has established a comprehensive medical insurance payment framework, but the content and progress of the reform are unbalanced, and have not yet played a leading role in stimulating the transformation towards health. Continuously advancing the reform of medical insurance payment model and making adaptive adjustments to the reform content will be the focus of the work at next stage.

     

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