摘要
2016年7月,金华市对住院医疗服务按"病组点数法"付费,推进医保精细化管理,较好实现了医保基金提质增效的目标,但门诊医保支付管理不够精细,导致门诊医保基金支出迅猛增长。2020年起,金华市在全国率先开展门诊医疗服务按"APG点数法"付费改革试点。改革当年医保基金增长率由改革前的25%左右下降至10%以内,市本级门诊医保基金增长率7%,有效控制了医疗费用不合理增长,提升了医保治理能力。
In July 2016,Jinhua implemented the point method of payment for inpatient medical services according to the disease group,promoted the fine management of medical insurance,and achieved the goal of improving the quality and efficiency of medical insurance funds.But the management of outpatient medical insurance payment is not fine enough,which leads to the rapid growth of outpatient medical insurance fund expenditure.Since 2020,Jinhua has taken the lead in carrying out the pilot reform of APG point payment method for outpatient medical services.The growth rate of medical insurance fund dropped from about 25%to less than 10%,and the growth rate of medical insurance fund for outpatient service at the municipal level was 7%,effectively controlling the unreasonable growth of medical expenses and improving the ability of medical insurance management.
作者
江小州
Jiang Xiaozhou(Jinhua Healthcare Security Bureau,Jinhua,321000)
出处
《中国医疗保险》
2021年第8期49-52,共4页
China Health Insurance
关键词
总额预算
按人头包干
APG点数法付费
total budget
payment by number of persons
APG point method payment
作者简介
江小州,金华市医疗保障局医药服务管理处处长,主要研究方向:医疗保险服务管理及政策制定。
