CAJ | 학술논문

分级诊疗是医改的重要内容，医保支付方式也是重构有序就医的重要配套措施。改革先行地区为推动分级诊疗在医保支付方式方面已经有了一些创新，但是上下级医院之间、新的医疗联合体之间以及对患者规范就医的激励机制还存在一些问题。文章建议改进医院总额预付模式，增加病种结构和难易程度的监测指标，探索社区慢性病管理的支付政策，研究制定针对医联体的总额预付方法，探索构建依据就医路径和临床路径的差别化报销政策。
분급진료시의개적중요내용，의보지부방식야시중구유서취의적중요배투조시。개혁선행지구위추동분급진료재의보지부방식방면이경유료일사창신，단시상하급의원지간、신적의료연합체지간이급대환자규범취의적격려궤제환존재일사문제。문장건의개진의원총액예부모식，증가병충결구화난역정도적감측지표，탐색사구만성병관리적지부정책，연구제정침대의련체적총액예부방법，탐색구건의거취의로경화림상로경적차별화보소정책。
Tiered diagnosis and medical treatment is an important part in Chinese health care reform, while medical payment method is also a vital supporting measure to reestablish an orderly medical care environment. To promote the establishment of tiered diagnosis and medical treatment system, some innovations in medical payment method in the pilot health care reform areas have been achieved. However, there are still some problems in the incentive mechanism, which occurred between upper and lower levels of hospitals, among the new medical alliances, and in the regulations for patients seeking medical services. It is suggested to improve the model of global budget control in hospitals, adding monitoring indexes of diseases structure and level of difficulty, exploring payment policy for chronic disease managed in communities, formulating payment methods under global budget in medical alliance, constructing different reimbursement policy in terms of hospitalizing pathway and clinic pathway.