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全民医保改革下一步关键:支付方式将怎样变化

2017-09-10 11:46:38   新华网

近日,全国医疗(生育)保险工作座谈会暨深化支付方式改革部署会在黑龙江哈尔滨召开,以深化医保支付方式改革为契机,全面部署医保重点工作。会议以深化医保支付方式改革为契机,全面部署医保重点工作,并透出今后完善医保支付体系与支付机制的重要讯息,即贯彻落实《关于进一步深化基本医疗保险支付方式改革指导意见》,建立完善适应不同人群、不同疾病、不同服务特点的多元复合医保支付方式。

人社部副部长游钧出席会议时指出,要准确把握新时期医保改革发展的形势、特征和方向,着力破解制约发展的时代难题,朝着更高质量、更有效率、更加公平、更可持续的新发展目标,坚定不移地将医保改革进行到底。

游钧强调,当前要把支付方式改革放在全民医保改革的关键位置,深入贯彻落实《关于进一步深化基本医疗保险支付方式改革指导意见》,分类推进,建立完善适应不同人群、不同疾病、不同服务特点的多元复合医保支付方式。要重点推进按病种付费,开展按疾病诊断相关分组(DRGs)付费试点,进一步完善按人头、按床日等付费方式,强化医保对医疗服务行为的监管,完善医保协议管理,全面推进智能监控系统,加强配套改革。

游钧指出,要在深化支付方式改革的同时,统筹做好医保各项重点工作。要深入推进城乡居民基本医保制度统一和一体化管理,打好医保精准扶贫攻坚战,9月底前全面完成医保全国联网和跨省异地就医直接结算,稳妥推进两项保险合并实施试点,扎实推进长期护理保险制度试点并做好总结评估,主动推动“三医联动”改革。

据了解,按照国办发(2017)55号文(即《关于进一步深化基本医疗保险支付方式改革的指导意见》)所提出的目标,今年起进一步加强医保基金预算管理,全面推行以按病种付费为主的多元复合式医保支付方式。到2020年,医保支付方式改革要覆盖所有医疗机构及医疗服务,全国范围内普遍实施适应不同疾病、不同服务特点的多元复合式医保支付方式,按项目付费占比明显下降。

此项改革有以下几个关键着力点:

一是针对不同医疗服务特点,推进医保支付方式分类改革。

——对住院医疗服务,主要按病种、按疾病诊断相关分组付费,长期、慢性病住院医疗服务可按床日付费。

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