CAJ | 학술논문

医疗保险支付方式是医疗保险机构对医、患（参保人）的付费方式。支付方式改革是当今世界很多国家医改的核心与难题。湖南蓝山县和桑植县推行了限额付费方式改革,参合农民在乡镇卫生院看病就医,门诊、住院费用付费限额内如实自付,超额部分由新农合基金全额报销,同时,对卫生院实行诊疗人次费用、住院床日费用以及总费用控制,对医生实行绩效工资制。创造了有别于＂全民免费医疗＂的＂全民限费医疗＂新模式。推广这种新模式的路径是：明确医疗服务的享受主体、服务主体及范围,科学制定总额预付标准,完善监管机制,建立医疗服务与社会医疗保险二位一体的新体制等。
의료보험지부방식시의료보험궤구대의、환（삼보인）적부비방식。지부방식개혁시당금세계흔다국가의개적핵심여난제。호남람산현화상식현추행료한액부비방식개혁,삼합농민재향진위생원간병취의,문진、주원비용부비한액내여실자부,초액부분유신농합기금전액보소,동시,대위생원실행진료인차비용、주원상일비용이급총비용공제,대의생실행적효공자제。창조료유별우＂전민면비의료＂적＂전민한비의료＂신모식。추엄저충신모식적로경시：명학의료복무적향수주체、복무주체급범위,과학제정총액예부표준,완선감관궤제,건립의료복무여사회의료보험이위일체적신체제등。
Health insurance is the principal part of medical security. The payment pattern of health insurance is the way how the medical insurance institutions, as the subjects of payment, insure those insured against losses due to ill health. Its game strategies with the hospital, the patient and the insurance institution interact as cause and effect. The reform in payment pattern is the core and puzzle of health care reform in many countries today. In pace with the establishment and development of social medical insurance system over the past 10 years, China has been exploring and reforming the payment pattern of health insurance but bears no satisfying fruit. In 2011, Sangzhi County and Lanshan County of Hunan province highlighted the reform in the payment which, health centers in villages and towns charge the insured patients within pattern of those insured, according to certain limits, namely, insured patients pay for the fees within the limits while the new rural cooperative fund cover the exceeding ones. This created a new mode of ＂limited cost for medical service＂ other than ＂no cost for medical service＂. Meanwhile, the reform in the payment pattern of the hospital is on the march. The cost for each patient＇ s visit, each bed per day and the total cost of the health center is under control and doctors are paid based on their performance. It has been proved that ＂limited cost for medical service＂ is likely to pave the new way for China＇s universal health care, and is necessary to be popularized by reform in system and mechanism.