摘要
目的:在推进紧密型县域医共体建设背景下,构建一套兼顾公平与激励的医保基金总额预算测算方案。方法:通过比较分析,优化由非协商因素和协商因素组成的测算框架;基于Y市医保结算与统计数据进行拟合并滚动预测。结果:多数年份各紧密型县域医共体医保基金预算拟合误差控制在5%以内。结论:采用非协商因素、协商因素、年度滚动校正的分层测算与决策框架,推进区域总额预算精细化改革,完善医疗机构质量绩效对接与结余激励,推动支付方式由“控费导向”向“控费+提质”协同转型。
Objective:To develop an operational global-budget estimation framework for tightly County Medical Communities(CMCs)that balances equity and incentives.Methods:The budget-setting practices was reviewed to promote a two-step framework combining non-negotiable factors and negotiable factors.Using medical insurance settlement and statistical data,rolling forecasts,and compare errors against benchmark models were conducted.Results:In most years,the fitting error at Tightly Integrated County CMC level stays within 5%.Conclusion:A tiered calculation and decision-making framework incorporating non-negotiable factors,negotiable factors,and annual rolling adjustments should be adopted to advance the refined regional total budget reforms.This framework will enhance the linkage between healthcare institutions’quality performance and surplus incentives,driving a coordinated shift in payment methods from a“cost-control-oriented”approach to a“cost control+quality improvement”model.
作者
李翔
张春峰
李玲
刘丹
Li Xiang;Zhang Chunfeng;Li Ling(National School of Development,Peking University,Beijing,100871,China;不详)
出处
《中国卫生经济》
北大核心
2026年第2期19-25,共7页
Chinese Health Economics
基金
潍坊市中央财政支持公立医院改革与高质量发展示范项目委托课题(2024WF04)
中国博士后科学基金面上项目(2024M760035)。
关键词
紧密型县域医共体
医保保障基金
总额预算
国际经验
tightly integrated county medical community
medical insurance fund
global budget
international experience
