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文章从当前我国医保费用支付方式存在的问题入手,在综合运用临床审计、临床路径和质效补偿等领域理论的基础上,提出了基于效果与质量的医保费用支付方式。期望通过从诊疗服务效果与质量方面以及诊疗服务与医保监管方面提出有针对性的具体措施,实现诊疗服务效果和质量标准化、医保费用审核和监督科学化,以及医保费用支付范围和流向合理化等目标。
This article starts with the current problems of medical insurance payment in our country. Based on the comprehensive utilization of the theory of clinical audit, clinical path and quality compensation, the paper proposes the payment method of medical insurance premium based on effect and quality. It is expected to achieve the goals of effectiveness and quality of diagnosis and treatment services, examination and supervision of medical insurance expenses and the rationalization of medical insurance fee payment scope and flow direction by putting forward specific and specific measures in respect of the effectiveness and quality of medical service, as well as the supervision and treatment services and medical insurance supervision .