天津市医疗保障局于2021年8月制定了《天津市区域点数法总额预算和按病种分值付费管理办法》,该管理办法将以往对单家医疗机构进行总额预算管理的模式调整为全面区域点数法总额预算管理。在制度设计过程中,天津市医疗保障局着力保障点数法与各种具体支付方式的顺畅结合,保留了按人头付费、按病种付费、按项目付费等原有支付方式的激励约束机制,并在制度设计中全面考虑了区域点数法对医疗服务提供者、医疗产品提供者、患者等利益相关方的改革目标与利益平衡,是天津医保支付方式改革的一次大胆尝试和创新。

Tianjin Healthcare Security Administration formulated the Measures of Tianjin for Total Budget based on Regional Points Method and Big Data Diagnosis-Intervention Packet in August 2021, which adjusted the previous model of total budget for single-hospital to the model based on regional points method. In the process of system design, Tianjin strives to ensure the smooth integration of the points method and various specific payments, and retains the original incentive and restraint mechanisms for payments such as capitation, DRG/DIP, and fee-for-service, taking into account the reform goals and interests of all parties, such as the provider of medical services and products. The practice is a bold attempt in reform of medical insurance payment in Tianjin.