| 引用本文：陈迎春, 谭华伟.中国紧密型县域医共体医保支付的财务脆弱性与风险保护：风险识别、经验镜鉴与政策路径[J].中国卫生政策研究,2022,15(11):1-10 |
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| 中国紧密型县域医共体医保支付的财务脆弱性与风险保护：风险识别、经验镜鉴与政策路径 |
| 投稿时间：2022-10-08 修订日期：2022-11-03 PDF全文浏览 HTML全文浏览 |
| 陈迎春, 谭华伟 |
| 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:抗风险能力是医共体高质量可持续发展的关键。识别医保基金流动和风险转移过程中可能损害医共体医保支付预算充足性、支付有效性、结算激励性的风险源，能有效移除紧密型县域医共体医保支付的财务脆弱性。本文首先搭建了紧密型县域医共体医保支付脆弱性形成机制的分析框架，对侵蚀医保支付的预算充足性、支付兼容性、结算激励性多元风险进行风险识别。在系统调研国际上整合型医疗组织以价值和人口基础支付、风险调整、风险走廊、医保支付充足性评价为核心的财务脆弱性风险保护经验的基础上，结合中国实际，从预算充足性、支付兼容性、结算激励性、医保支付充足性评估四个维度构建紧密型县域医共体医保支付财务脆弱性的风险保护机制。 |
| 关键词:市级统筹 县域医共体 医保支付 财务脆弱性 风险保护 |
| 基金项目:国家自然科学基金面上项目（71974066） |
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| Financial vulnerability and risk protection of health insurance payments of compact county healthcare alliances in China: Risk identification, empirical research and policy reference |
| CHEN Ying-chun, TAN Hua-wei |
| School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei 430030, China |
| Abstract:Risk resilience is the key to high-quality and sustainable development of closely-knit county healthcare communities. Identifying the risk sources in the flow of health insurance fund and risk transfer that may undermine the budgetary adequacy, payment effectiveness and settlement incentives of health insurance payments in compact county healthcare communities can effectively work on the financial vulnerability of them. This paper first builds an analytical framework for the formation mechanism of vulnerability in health insurance payment among health care communities in tightly-knit counties, so that risks of inadequate health insurance payment budget, incompatibility of different means of payment and lack of incentives for settlement are identified. On systematic research on international experience of financial vulnerability risk prevention, featuring value and population-based payments, risk regulation, risk corridors, and assessment of adequacy of health insurance payments, a risk-prevention mechanism aiming at protecting health insurance payments among health care communities in China's tightly-knit counties is proposed. This mechanism gives consideration to actual situations in China, and take four dimensions into account in terms of risk-prevention, namely adequacy of budget, compatibility of payment, incentives for settlement, and adequacy assessment of ability of medical insurance to pay among healthcare communities in China's compact counties. |
| Key words:Municipal coordination County's healthcare alliance Health insurance payment Financial vulnerability Risk prevention |
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