实行医疗保险总额预付制改革的思考

总额预付制是由医保部门在对医疗机构进行评估后，计算出人均医疗费用，根据服务量和人均医疗费用，测算出医院的年度费用标准，按此费用标准向医院预付定额的医疗费。对上海医保总额预付制的模式、实施成效、存在的问题进行了思考和探讨，对总额预付的运用及改进提出了初步的设想，以此推动医疗保险付费方式改革的持续进展。

Thinking on the Implementation of Total Prepaid Medical Insurance Reform

In a total prepaid system, medical insurance bureau makes evaluation of medical institutions and calculates per capita health care costs. Based on service volume and per capita health care costs, the bureau estimates annual cost standard for a hospital and prepays fixed medical expenses according to this standard. This paper made reflections and discussions on Total Prepaid Medical Insurance System in Shanghai in terms of its mode, effectiveness of implementation and existing problems. Preliminary ideas were proposed on the application and improvement of total prepaid system, with an aim to promote the continued progress of medical insurance payment reform.