| 引用本文：冯毅, 姚岚.典型发达国家和地区门诊保障政策比较及经验启示[J].中国卫生政策研究,2016,9(7):46-52 |
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| 典型发达国家和地区门诊保障政策比较及经验启示 |
| 投稿时间：2015-11-27 修订日期：2016-04-12 PDF全文浏览 HTML全文浏览 |
| 冯毅1, 姚岚2 |
1. 遵义医学院管理学院 贵州遵义 563003;
2. 华中科技大学同济医学院医药卫生管理学院 湖北武汉 430030 |
| 摘要:利用文献综述法梳理典型发达国家门诊保障的相关政策并进行比较分析，为我国构建具有中国特色的门诊保障制度提供参考借鉴。分析认为可供我国借鉴的经验为：门诊统筹是医疗保险发展的必然趋势，是其有机组成部分，原则上不用单独缴费筹资；应该因地制宜制定门诊社区首诊政策；根据门诊服务的提供管理方式来确定供方的补偿方式及门诊待遇目录的详细程度；分类管理门诊服务，并分别制定支付政策；把监管的重点放在对门诊医生的管理上，外部监管应是符合目前我国情况的监管方式；患者也要承担一定的门诊支付责任，但医保支付封顶线不宜过低；对弱势群体实行一定的倾斜政策，可以考虑在统一制度下对其医药费用进行部分减免。 |
| 关键词:门诊保障 医疗保险 政策比较 经验借鉴 |
| 基金项目:贵州省哲学社会科学规划课题（13GZYB24） |
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| Policy, experience and implications of outpatient security in typical developed countries |
| FENG Yi1, YAO Lan2 |
1. School of Administration, Zunyi Medical College, Zunyi Guizhou 563003, China;
2. School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei 430030, China |
| Abstract:This paper reviews outpatient security policy of typical developed countries. It provides reference for outpatient security system in China. Analysts believe that the experience for Chinese reference should be acquired in the following ways: The pooling of outpatient service is an inevitable trend in the development of health insurance, which is in principle an integral part of payment and financing system; the implementation of outpatient community first diagnosis system should be adapted to the local conditions; the community first diagnosis system is a necessary condition for capitation, so it is closely related to compensation methods and the elaborate degree of outpatient treatment catalog; Outpatient services should be supervised and payment policies should be developed respectively. There are two supervision models about outpatient service: external supervision and self supervision, but the key is to focus on the management of outpatient doctors. External regulation should be consistent with the current regulatory approach of the situation and patients have to bear some responsibilities for outpatient treatment expenses in some proportions, but the payment cap line should not to be low. The implementation of certain preferential policies for vulnerable groups can be considered under the harmonized system to partially reduce their medical expenses. |
| Key words:Outpatient security Medical insurance Policy comparison Experience reference |
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