| 引用本文：张小娟.基于门诊和住院保障的视角重构医保待遇保障组合[J].中国卫生政策研究,2021,14(5):21-27 |
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| 基于门诊和住院保障的视角重构医保待遇保障组合 |
| 投稿时间：2021-03-10 修订日期：2021-05-10 PDF全文浏览 HTML全文浏览 |
| 张小娟1,2 |
1. 中国医学科学院医学信息研究所 北京 100020;
2. 中国人民大学公共管理学院 北京 100872 |
| 摘要:本文梳理了基本医保门诊保障政策的形成和变迁，并实证分析门诊费用是引致疾病经济风险的重要原因。由于对门诊费用和门诊保障的认识并未跟进，造成门诊保障政策的不完善和门诊保障不足。建议重构医保待遇保障组合，瞄准风险提高医保制度的经济风险保护效能。 |
| 关键词:待遇保障组合 门诊保障 板块式支付 |
| 基金项目:国家自然科学基金（573276）；深圳市卫生系统科研项目资助（SZWG2018001） |
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| Reconstruction of the medical insurance benefit package based on the perspective of outpatient and inpatient cost protection |
| ZHANG Xiao-juan1,2 |
1. Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing 100020, China;
2. School of Public Administration and Policy, Renmin University of China, Beijing 100872, China |
| Abstract:This paper analyzed the formation of and changes in outpatient cost protection policies related to the basic medical insurance, and empirically analyzed the outpatient cost as an important cause of healthcare financial risks. However, because the theoretical understanding of outpatient costs and compensation has not been thoroughly followed up, the outpatient cost compensation policy is imperfect and the outpatient cost protection is inadequate. It is recommended that the medical insurance benefit package should be restructured, and the risks should be rationally investigated and mitigated in order to realize effective health financial risk protection. |
| Key words:Medical insurance benefit package Outpatient cost protection Separated out-inpatient cost payment |
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