中国全科医学Issue(29)：3533-3536,4.DOI:10.3969/j.issn.1007-9572.2015.29.006
全科医生按人头医保全口径预付管理方案的模式架构探讨
Pattern and Framework of the Management Plan of Full - caliber Health Insurance Prepayment Managed by General Practitioners According to the Number of Patients
摘要
Abstract
Objective To explore the pattern and framework of the management plan of full - caliber health insurance prepayment plan managed by general practitioners according to the number of patients,in order to provide solutions for the problems like difficulty of government in determining the total amount of health insurance,the reluctance of medical settings to admit patients with health insurance and poor service quality of medical settings for patients with health insurance. Methods In this study,we adopted the combination of theoretical research and empirical research method. Through referencing the foreign experience of health insurance cost control and absorbing the research results of domestic research institutions,we explore methods and measures for the reasonable control of health insurance cost appropriate for China's national condition and the needs of health development. Results A management plan of full - caliber health insurance prepayment by the number of patients was built,with the signed residents who received treatment in community health service centers as prepayment objects,signed general practitioners as persons in charge,community clinical pathway as management tool,and with the standard - reaching rate of disease control,the rationality of cost management and the satisfaction degree of patients as criteria,thus a mode according with objective reality was formed. Conclusion Health insurance full - caliber prepayment by the number of patients under GP contract - signing family service system can be tried,so as to make general practitioners become the real gatekeepers of community health services. However,the mode is not mature yet,which needs further verification.关键词
全科医生/保险,长期医疗/预付费卫生计划/费用控制Key words
General practitioners/Insurance,long - term care/Prepaid health plans/Cost control分类
医药卫生引用本文复制引用
戴慧敏,寿涓,成园,杜兆辉..全科医生按人头医保全口径预付管理方案的模式架构探讨[J].中国全科医学,2015,(29):3533-3536,4.基金项目
上海市浦东新区卫生与计划生育委员会社区卫生项目（PW2014C -26）；上海市浦东新区卫生系统重点团队建设资助项目 （）
