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医保总额控制付费是各国常用的一种控制医疗费用过快增长、确保医保基金安全平稳运行的常用方法,总控指标的设定方式直接影响到这种付费方式的实际执行效果。在医保总控付费方式中引入调整系数可以较好地实现总控付费的制度设计预期,努力实现在基本医疗服务提供系统内构建激励与约束并重的运行机制。
The total amount of medical insurance control paid is commonly used in various countries to control the excessive growth of medical costs to ensure the safe and stable operation of the Medicare Fund, a common method of setting the total control index directly affects the actual implementation of this payment method. The introduction of adjustment coefficient in the total control and payment mode of medical insurance can better realize the system design expectation of total control payment and strive to construct the operation mechanism of both incentive and constraint in the basic medical service delivery system.