中国医疗保险
中國醫療保險
중국의료보험
CHINA HEALTH INSURANCE
2014年
12期
31-34
,共4页
按人头付费%门诊首诊%费用结算
按人頭付費%門診首診%費用結算
안인두부비%문진수진%비용결산
per capitat payment%first contact care in outpatient department%expense settlement
按人头付费通过调节医疗保险基金流向，促进基层医疗机构从注重疾病治疗向健康保障、疾病预防转变，改变参保人就医行为，引导卫生资源合理配置。本文简要介绍东莞现行的社区门诊结算方式和按人头付费方式上的改革历程，从首诊制、总额确定方法、付费管理办法、年终清算激励机制四方面进行回顾，了解东莞在这些关键点上的做法、遇到的问题，以及解决问题的思考和探索。
按人頭付費通過調節醫療保險基金流嚮，促進基層醫療機構從註重疾病治療嚮健康保障、疾病預防轉變，改變參保人就醫行為，引導衛生資源閤理配置。本文簡要介紹東莞現行的社區門診結算方式和按人頭付費方式上的改革歷程，從首診製、總額確定方法、付費管理辦法、年終清算激勵機製四方麵進行迴顧，瞭解東莞在這些關鍵點上的做法、遇到的問題，以及解決問題的思攷和探索。
안인두부비통과조절의료보험기금류향，촉진기층의료궤구종주중질병치료향건강보장、질병예방전변，개변삼보인취의행위，인도위생자원합리배치。본문간요개소동완현행적사구문진결산방식화안인두부비방식상적개혁역정，종수진제、총액학정방법、부비관리판법、년종청산격려궤제사방면진행회고，료해동완재저사관건점상적주법、우도적문제，이급해결문제적사고화탐색。
Per capita payment promotes basic medical institutions changing from emphasizing on disease treatment to the health care and disease prevention by adjusting the medical insurance fund flows. It also changes the insured medical behavior and guides the rational allocation of health resources. This paper introduces the current settlement methods for community outpatients of Dongguan, shows the reform process of per capita payment. It reviews the experience in four aspects such as first contact care at community health services centers, the total payment determination method, payment management, year-end settlement inspiration mechanisms, to help understanding the practice, problems, and solution methods in these key points in Dongguan.
