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总额控制将全面推开人社部、财政部、卫生部近期发布《关于开展基本医疗保险付费总额控制的意见》,要求用两年左右时间,在国内所有统筹地区开展医保付费的总额控制。笔者认为,有几点是需要指出的(1)要按照以收定支、收支平衡、略有结余的原则,确定医疗保险基金向区域内定点医疗机构支付的年度总额控制目标;(2)按照医疗机构不同级别、类别定点服务范围、有效服务量、首诊、转诊,区分门诊、住院等费用,实行差别支付、注重向基层倾斜、确定各定点医
The total amount of control will be pushed to a full scale by the Ministry of Human Resources and Social Security. The Ministry of Finance and the Ministry of Health recently released the Opinions on Controlling the Total Payment of Basic Medical Insurance, and demanded that the total amount of medical insurance paid be controlled in all co-ordinating areas within two years. The author believes that there are several points that need to be pointed out: (1) According to the principle of accepting payment, balance of payments and a slight balance, the annual total amount control targets that the medical insurance fund pays to the designated medical institutions in the region shall be determined; (2) In accordance with the different levels of medical institutions, the scope of fixed-point service, effective service volume, first visit, referral, distinction between outpatient and inpatient fees, the implementation of differential payment, pay attention to grass-roots tilt, to determine the fixed-point