典型发达国家和地区门诊保障政策比较及经验启示

发布时间：2019-07-29 18:13

【摘要】：利用文献综述法梳理典型发达国家门诊保障的相关政策并进行比较分析,为我国构建具有中国特色的门诊保障制度提供参考借鉴。分析认为可供我国借鉴的经验为:门诊统筹是医疗保险发展的必然趋势,是其有机组成部分,原则上不用单独缴费筹资;应该因地制宜制定门诊社区首诊政策;根据门诊服务的提供管理方式来确定供方的补偿方式及门诊待遇目录的详细程度;分类管理门诊服务,并分别制定支付政策;把监管的重点放在对门诊医生的管理上,外部监管应是符合目前我国情况的监管方式;患者也要承担一定的门诊支付责任,但医保支付封顶线不宜过低;对弱势群体实行一定的倾斜政策,可以考虑在统一制度下对其医药费用进行部分减免。
[Abstract]:By using the method of literature review, this paper combs the relevant policies of outpatient security in typical developed countries and makes a comparative analysis, so as to provide reference for the construction of outpatient security system with Chinese characteristics in China. The analysis shows that the experience that can be used for reference in our country is as follows: outpatient planning is the inevitable trend of the development of medical insurance and an organic part of it, in principle, there is no need to pay separate fees to raise funds; the policy of outpatient community first diagnosis should be formulated according to local conditions; the compensation mode of supplier and the detail degree of outpatient treatment catalogue should be determined according to the management mode of outpatient service provision; the outpatient service should be classified and managed, and the payment policy should be formulated separately. The focus of supervision should be on the management of outpatient doctors, external supervision should be in line with the current situation of our country; patients should also bear a certain responsibility for outpatient payment, but the top line of medical insurance payment should not be too low; to implement a certain tilt policy for vulnerable groups, we can consider partial reduction and reduction of their medical expenses under the unified system.
【作者单位】：遵义医学院管理学院;华中科技大学同济医学院医药卫生管理学院;
【基金】：贵州省哲学社会科学规划课题(13GZYB24)
【分类号】：R197.1;F842.684

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