重庆市医联体医保支付改革研究

医联体是医改的重要内容，医保支付改革是医联体重要的内生动力。目前医联体与医保改革并不完全合拍，导致医保对患者的引导不足，医联体内生动力机制缺失。为探究新型医联体内医保支付改革方式，本课题组对重庆市医联体现状和医联体内医保支付方式进行研究，指出重庆市医联体内医保支付存在的问题，提出适合重庆市医联体的医保支付改革策略，为医联体的完善提供政策建议。结果显示，重庆市建立了以托管模式、分院模式、县域技术帮扶模式为主的医联体，实行了医保基金市级统筹，建立了多元混合式医保支付模式，减少了转诊的“门槛费”。但仍存在医联体内医保基金不能相互调剂使用、医联体与医保之间缺乏联动、医保支付方式不完善、缺乏相应的绩效考核办法等问题。建议构建紧密型医联体，允许医联体内医保基金相互调剂，健全医疗质量与绩效考核体系、激励约束机制，制定相关医保政策，合理确定预算总额，完善医保支付方式。

Medical Insurance Payment Reform of Chongqing Medical Consortium

Medical consortium is an important part of medical reform，and medical insurance payment reform is a major endogenous driving force of medical consortium reform.But the development of the two is not well coordinated，resulting in decreased effect of health insurance programs in promoting initial consultation in primary care，and lack of dynamic cooperation mechanism between the institutions within a medical consortium.Analysis the status of medical consortiums，and the medical insurance payment modes in Chongqing.Points out the existing problems of medical insurance payment in Chongqing medical association，puts forward the reform strategy of medical insurance payment suitable for Chongqing medical association，and provides policy suggestions for the improvement of medical association.The interview results showed that Chongqing has established three modes of medical consortiums（trustee model，branch mode and county technical assistance mode），pooled health insurance funds from the municipal government agencies successfully，established mixed medical insurance payment modes，and reduced the threshold for using medical insurance payment for those transfered treatment.However，many problems are needed to be solved，such as medical insurance funds can not be mobilized from the institution with a surplus to that with a deficit within the medical consortium，lack of linkage between the medical consortium and medical insurance payment，the imperfect payment mode of medical insurance，and lack of corresponding performance appraisal methods.In view of this，we put forward the following suggestions：building a compact type of medical consortium，allowing the appropriate mobilization of the medical insurance funds from an institution with a surplus to that with a deficit within the medical consortium，improving the healthcare quality and performance appraisal system and incentive and restraint mechanisms for healthcare providers，formulating relevant medical insurance policies if needed，rationally determining the total budget for medical insurance programs，and improving the payment modes of medical insurance.All these contribute to the exploration of new modes of medical insurance payment reform，and of policy recommendations for the development of medical consortium at the national level.