紧密型医联体的建设是我国建立优质高效整合型医疗卫生服务体系的重要尝试,科学合理的医保支付方式是保障医联体高质量发展的重要机制。本文系统梳理了国内外整合型医疗卫生服务体系的支付机制现状,剖析了现阶段紧密型医联体支付制度安排的相关问题,重点围绕总额付费的总额测算思路、总额付费基础上的多元复合式医保支付方式、结余留用和合理超支分担机制、相应的监督考核办法等方面,进一步分析了医联体医保支付方式改革的调整优化策略,供实践参考。

The establishment of close-knit medical consortia represents a significant endeavor in China's pursuit of a high-quality, efficient, and integrated healthcare service system. A scientifically sound healthcare insurance payment mechanism is pivotal to ensuring the effective operation of these close-knit medical consortia. This paper provides an overview of the current status of healthcare insurance payment mechanisms for integrated healthcare service systems both domestically and internationally. It comprehensively analyzes the existing issues in the payment methods of close-knit medical consortia at present. Furthermore, the paper proposes adjustment and optimization strategies for the reform of healthcare insurance payment mechanisms in close-knit medical consortia, including the global budget calculation methods, the multiple composite healthcare insurance payment methods on the basis of global budget, the balance retention and reasonable over-expenditure sharing mechanism, and the corresponding supervision and assessment methods, which can be used as a reference for practice.