在医保市级统筹的背景下,实施区域总额预算下的DRG/DIP医保支付方式改革和建立紧密型县域医共体双重改革时,探索区域总额预算管理下的紧密型县域医共体“打包”付费机制是亟待解决的问题,对协调统筹区与县域医共体支付方式差异、确保上述两项改革目标的实现有重要意义。本文通过梳理相关政策和研究文献,基于笔者自身在医保支付方式改革工作实践过程中的思考,提出了对紧密型县域医共体医保基金“打包”付费预算的政策建议。对于目前处于探索和试点阶段的改革来说,这种政策思考还有待实践进一步检验和完善。

On the basis of municipal pooling, implementing the dual reforms of DRG/DIP medical insurance payment methods under the condition of regional total budget management, establishing a compact medical consortium within a county area will face an urgent problem of exploring the "package payment" budget mechanism for the medical consortium under the regional total budget management, which will be of great significance for coordinating the differences in payment methods between the municipal pooling district, the pilot counties of medical consortium so as to ensure the realization of the two reform objectives. By analyzing relevant national, local policies, based on the author's own reflections on payment method reform in practice, this paper puts forward some suggestions for the "package payment" budget of the medical insurance fund. For reform in the preliminary exploration, pilot stage, these suggestions need to be further tested, improved in practice