摘要
目的:比较分析国内外“互联网+”医疗服务支付现状,为完善我国“互联网+”医疗服务医保支付政策提供参考。方法:通过文献研究法,对比分析美国、澳大利亚、法国、德国及我国“互联网+”医疗服务医保支付政策。结果:各国“互联网+”医疗服务均由公共医疗保险与商业医疗保险共同保障;多数国家采用与线下服务一致的支付标准,并采用按项目付费的支付方式,普遍设有支付限制。我国“互联网+”医疗服务主要由基本医疗保险保障,支付内容以互联网复诊为主,医保准入标准尚不明确,医保支付缺乏有效的风险管控。结论:借鉴国际经验,我国应制定“互联网+”医疗服务动态准入规则,完善医保支付政策,鼓励商业医疗保险参与,健全多层次保障体系,促进“互联网+”医疗服务高质量发展。
Objective To systematically review and compare the current status of"Internet+"medical service payment systems domestically and internationally.Methods Using a literature review approach,the medical insurance payment policies for"Internet plus"medical services in the United States,Australia,France,Germany and China were compared and analyzed.Results In the selected countries,"Internet+"medical services were jointly covered by public and commercial health insurance.Most countries adopted payment standards consistent with those for face-to-face services and used a fee-for-service model,with widespread payment restrictions.In contrast,"Internet+"medical services in China were primarily covered by basic medical insurance,with a focus on online follow-up consultations.Conclusion Drawing on international experience,China should establish dynamic access rules and adjustment mechanisms for"Internet+"medical services,refine related medical insurance payment policies,and encourage active participation from commercial health insurance,so as to facilitate the gradual construction of a medical insurance payment system that supports the high-quality development of"Internet+"medical services.
作者
童禧辰
张璐莹
李凯渊
张森伟
苟菲菲
陈文
TONG Xichen;ZHANG Luying;LI Kaiyuan;ZHANG Senwei;GOU Feifei;CHEN Wen(School of Public Health,Fudan University,Shanghai 200032,China;不详)
基金
国家自然科学基金专项项目“价值医疗导向下激励相容的支付体系研究”(72342016)
国家自然科学基金面上项目“战略性购买视角下医保门诊按人头付费机制研究”(72374049)
复旦大学卫生经济学与政策研究“明日之星科研基金”(第七期)“基于国际经验的互联网医疗服务医保支付研究”。
关键词
“互联网+”医疗服务
医保支付
国际经验
"Internet+"medical service
medical insurance payment
international experience
