| 摘要: |
| 医疗保险以控制医疗费用为重要职能，以预付费方式为主要手段。医疗保险预付费方式实际上是一种“定额”付费方式，以“超支自负和结余归己”的固定结算制度为控费机制。目前，部分地区的医保机构对医疗机构采取“超支分担、结余奖励”的弹性结算制度，部分地区对医疗机构采取“超支自负、结余归人”或“超支分担、结余归己”的半固定半弹性结算制度。这些结算制度不是“定额”付费方式，而且“限额”付费方式，原本是为了既控制医疗费用又防范医疗风险，结果是既不能控制医疗费用又不能防范医疗风险。 |
| 关键词: 医疗保险 后付费方式 预付费方式 医疗费用 医疗风险 |
| DOI： |
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| 基金项目: |
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| Mechanism of Prepaid Method of Medical Insurance in Controlling Medical Expense |
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| Abstract: |
| To control the medical expenditure is an important function of medical insurance. Prepaid method is main way to control the medical expenses. Medical insurance prepaid is actually a "quota" payment, "overruns in vain and surplus for yourself" is the main mechanism of prepaid method control expenses. At present, health insurance institutions adopt flexible payment or semi-fixed and semi-flexible payment in some areas. The payment method is not a "quota" payment but a "limit" payment, with a view to not only control the medical expenses but also prevent medical risk, however it can not control medical expenses and can not prevent medical risks ultimately. |
| Key words: medical insurance, postpaid method, prepaid method, medical expenses, medical risk |
