(声明：刊用《中国新闻周刊》稿件务经书面授权) (statement:reproduced[China news weekly]For the manuscript written authorization)

　　迫于日益增大的医保基金支付压力，目前国内已经有上海、北京等多个城市在医疗机构中，扩大试行总额支付制度的试点。不过，为了避免总额预付所导致的医院推诿危重病人、医疗服务质量下降等不良后果，不论是北京还是上海，都对其进行了必要的改良

Under the increasing levels of medical insurance fund pays pressure,At present domestic have Shanghai/Beijing and other cities in the medical institutions,To expand the pilot trial amount payment system.but,In order to avoid the total advance in hospital shuffle the critically ill patient/Medical service quality and other adverse consequences,Whether Beijing or Shanghai,All the necessary improvement

　　本刊记者/陈纪英

This reporter/ChenJiYing

　　在推广哪种医保支付方式的问题上，北京市似乎已经找到了答案。

What kind of medical insurance payment in the promotion of the problem,Beijing seems to have found the answer.

　　《中国新闻周刊》近日从多位北京医药卫生界人士处获悉，2011年一度被看好的按疾病诊断相关分组(DRG)付费制度，其试点进度已经放缓，目前，北京正在力推另外一种付费模式——总额预付制度。目前，国内医保支付方式，一般分为预付制和后付制两种，前者按项目付费，看多少病，支付多少钱，绝大多数地区都采取这种模式，而后者包括单病种付费，DRG，总额预付等等，其中控费效果最为显著、医院分担风险最大的就是总额预付制。

[China news weekly]Recently more than from Beijing medical WeiShengJie people have learned,2011 years has been valued by disease diagnosis related group(DRG)Pay system,The pilot progress has been slow,At present,Beijing is pushing another pay the total model - prepaid system.At present,The domestic medical insurance payment,Generally divided into prepaid system and pay system after two,The former item pay,Look how many disease,Pay much money,The vast majority of regions to take this model,While the latter paid including single disease,DRG,Amount prepaid, etc,The control fee the most effective/The hospital is the biggest risks total prepaid system.

　　北京市人力与社会保障局副巡视员蒋继元今年9月在中国人民大学举行的首届北京市公立医院改革实践高峰研讨会上透露了北京市的这一政策转向：总额预付制度将在2010年4家三甲医院试点的基础上，在2012年扩大到33家，包括了市属、部队、以及区县的二级医院。知情人士透露，北京市可能在2013年将试点扩大到所有二、三级医院。

Beijing human and social security bureau deputy inspector JiangJiYuan September this year the people's university of China the first Beijing held public hospital reform practice peak conference revealed that the Beijing's the policy change:The total advance system will in 2010 four 3 armour hospital on the basis of the pilot,In 2012 it expanded to 33 home,Including under the/forces/And the area county secondary hospital.insider,Beijing may be in 2013 will expand the trial to all the second/Tertiary hospital.

　　迫于日益增大的医保基金支付压力，目前国内已经有上海、北京等多个城市在医疗机构中，扩大试行总额支付制度的试点。不过，为了避免总额预付所导致的医院推诿危重病人、医疗服务质量下降等不良后果，同时也为了缓解医疗机构对于改革的疑虑，减少改革阻力，不论是北京还是上海，都对其进行了必要的改良。

Under the increasing levels of medical insurance fund pays pressure,At present domestic have Shanghai/Beijing and other cities in the medical institutions,To expand the pilot trial amount payment system.but,In order to avoid the total advance in hospital shuffle the critically ill patient/Medical service quality and other adverse consequences,At the same time in order to alleviate the reform of medical institution for doubt,Reduce reform resistance,Whether Beijing or Shanghai,All the necessary improvement.

　　在2012年年初的全国卫生工作会议上，卫生部部长陈竺表示，要大力推进支付制度改革，确定适应不同层次医疗机构、不同类型服务的支付方式，用总额预付、按病种、按服务单元、按人头等支付方式替代按项目付费。

In the early 2012 national health work meeting,The ministry of health minister Outlines said,We need to vigorously push forward payment system reform,Sure adapt to different level medical institutions/Different types of payment service,The total advance with/Press disease to/According to the service unit/According to the people the first payment alternative item pay.

　　

总额预付渐成京沪主流 The total advance gradually into the beijing-shanghai mainstream

　　比北京更早推广总额预付制的是上海。在很多医药卫生界人士看来，这主要因为上海医保基金的控费压力比较大。

Beijing earlier than the total promotion in advance system is Shanghai.In many medical WeiShengJie people it seems,This is mainly because the Shanghai medical insurance fund control cost pressure is bigger.

　　2001年，上海率先在国内建成城镇职工基本医疗保险制度，当年，医保基金的支出增幅就超过30%，医保部门的控费压力骤然增加。此后，从2002年到2007年，上海医保统筹账户连年收不抵支，5年中，医保缺口累计已达20亿元。

In 2001,,Shanghai took the lead in the country to built basic medical insurance system for urban employees,the,The medical insurance fund spending growth is more than 30%,Medical insurance department control cost pressure increase abruptly.Since then,From 2002 to 2007,The Shanghai medical insurance as a whole account in successive years close not to branch,Five years,Health gap accumulated has reached 2 billion yuan.

　　上海市最早在2002年启动总额预付的试点。但大规模推广是在2009年，当时上海市先在社区卫生服务中心全部实现医保总额预付，不久又将试点范围扩大到仁济医院、华山医院、上海第一人民医院这3家三级医院，2010年试点范围又进一步扩大到10家三级医院和该市全部公立二级医院；2011年，上海全市的全部三级医院均被纳入总额预付试点。

Shanghai first launched in 2002 the total advance of pilot.But a large-scale promotion is in 2009,At that time the Shanghai first in community health service center all realize total medical advance,Soon and will pilot expanded to yan chai hospital/Huashan hospital/Shanghai first people's hospital this three tertiary hospital,In 2010 the scope and further expand to 10 tertiary hospitals and all the city's public secondary hospital;In 2011,,Shanghai city all tertiary hospital were included in the total advance pilot.

　　在上海版的总额预付模式中，“总额预算、按月预付、结余自留、风险分担”被确定为四项基本原则。

In Shanghai version of the total advance mode,"Total budget/Monthly advance/Balance privately/Risk sharing"Be sure to the four cardinal principles.

　　上海版总额支付制度最显著的特点是“双总控”机制。该模式的控制手段之一是，医疗机构对超额部分承担比例的加大，前者的分担比例从初始的10%逐步提高至40%。经测算，分担比例提至四成后，医院冒险超支就能基本被遏制。同时，医保部门在控制总费用的基础上，增设了药品费用增速控制指标，医院药品费用原则上控制比上年增加7%左右，超过部分不予支付。

Shanghai edition amount payment system is the most significant characteristic"Double total control"mechanism.The model control method is one of the,Medical institutions to excess part undertake proportion of increase,The former share proportion from the initial 10% gradually raise to 40%.According to the calculation,Ask the allocation proportion to forty percent,Hospital risk overspending can basic be contained.At the same time,Health care providers in the control on the basis of total cost,Add the drug cost growth control index,The hospital drug expenses shall, in principle, control a year-on-year increase of 7%,The exceeded part does not grant to pay.

　　2010年上海全市33家三级医院的医疗总费用为331亿元，同比增长15%，增幅同比去年放缓了三分之一。由此，该市十年来医保费用快速上升的势头也首次得到了遏制。截至今年上半年，上海总额预付试点医院申报的医保费用，占定点医疗机构总费用的比重，已上升到四成左右，总额预付制度已经成为上海医保支付方式的主体。

2010 Shanghai city and home tertiary hospital medical cost $33.1 billion in total,Year-on-year growth of 15%,Year-on-year growth slowing a third last year.this,The city's ten years the medical insurance cost rapid rising momentum for the first time also has been contained.By the first half of this year,Shanghai amount prepaid pilot hospital to declare the medical insurance cost,Nod medical establishment of the proportion of total cost,Has risen to forty percent,The total advance system has become the main body of Shanghai medical insurance payment.

　　医保基金缺口现象并非上海独有。2012年8月初，广州市人力资源和社会保障局对外公布，随着医保待遇标准的不断调高以及医疗消费需求的增加，广州市的医保基金支付压力不断增大，2009年，广州市医保基金首次出现缺口，2010年，这一缺口达1.3亿元。

The medical insurance fund gap phenomenon is not Shanghai unique.In early August, 2012,Guangzhou human resources and social security bureau announced,Along with the medical insurance treatment standard constantly raised and the increase of medical consumer demand,Guangzhou medical insurance fund pays pressure increasing,In 2009,,Guangzhou medical insurance fund first appeared gap,In 2010,,The shortfall of 130 million yuan.

　　目前，北京市尚未传出医保基金出现缺口的消息，不过，蒋继元透露，2010年和2011年，北京市医保基金支出的增幅都超过了35%，从长远来看，北京市的医保基金面临的控费压力巨大。

At present,Beijing has not yet spread the news of the gap between the medical insurance fund,but,JiangJiYuan revealed,In 2010 and 2011,Beijing medical insurance fund of the increase of more than 35%,In the long run,Beijing's medical insurance fund faces enormous pressure control fee.

　　2011年下半年开始，北京开始在友谊医院、同仁医院等4家医院开展总额预付试点。不过，与上海不同，到了2011年底，北京4家医院均出现了超额现象。　

The second half of 2011 began,Beijing friendship hospital started in/Tongren hospital four hospitals, such as the total advance pilot.but,And Shanghai different,To the end of 2011,Beijing 4 hospitals all appear the phenomenon of excess.

　　北京同仁医院院长伍冀湘在9月初告诉《中国新闻周刊》，2011年，该院启动了总额预付，总额预付的费用占同仁医院收入的三分之一。2011年北京同仁医院超额额度在4家医院中排第三，超额700多万，超额幅度在4.3%左右。

Beijing tongren hospital dean WuJiXiang in early September tell[China news weekly],In 2011,,The hospital total launched in advance,The cost of the total advance of tongren hospital one third of her income.The 2011 Beijing tongren hospital in excess of line 4 hospitals ranked third,Excess of more than 700,Excess amplitude at around 4.3%.

　　伍冀湘预计，2012年北京同仁医院可能会继续超额。2012年1到6月，该院总额预算已经用去了全年计划额度的 47%左右，但是由于“下半年的工作量一般都要增加，年底可能还是要超额。”北京友谊医院执行院长辛有清透露，截止2012年7月31日，北京友谊医院总额预付已经用去全年计划额度的56%，“后半年可能压力会更大”，同样面临超额压力。

WuJiXiang is expected to,The 2012 Beijing tongren hospital may continue to excess.2012 years 1 to 6 months,The hospital total budget have used to about 47% of the amount of annual plan,But because"In the second half of the workload is generally going to increase,The end of the year may still want to excess."Beijing friendship hospital executive director of symplectic has clear revealed,By July 31, 2012,Beijing friendship hospital amount prepaid have used to 56% of the amount of annual plan,"Late may pressure will be greater",The same face excess pressure.

　　伍冀湘认为，控费压力应该由政府、医院和社会共同承担。

WuJiXiang think,Control cost pressure should be paid by the government/The hospital and social common bear.

　　不过，蒋继元透露，尽管4家试点医院2011年医保费用增长了14%，均出现超额，但明显低于全市三级综合医院同期的28%的增长幅度。

but,JiangJiYuan revealed,Although the four pilot hospital medical insurance expenses in 2011 increased by 14%,All appear excess,But obviously lower than the tertiary general hospital in the same period of the 28% increase.

　　

DRG缓行 DRG amble

　　除了总额预付，北京等地亦有医院在试点另外一种支付方式：DRG付费。

In addition to the total advance,Beijing also has a hospital in pilot another payment method:DRG paying.

　　在2011年10月，北京市共有6家医院进行了DRG的试点，相对于国内大部分医院实行的总额预算，DRG被认为是更为精细的支付制度设计。由于北京的医保基金控费压力比上海小，因此，业内人士常常把北京所推行的DRG模式和以总额预付为主体的上海模式进行比对、研究。

In October 2011,There are six hospitals of Beijing the DRG of pilot,Relative to the domestic most hospitals implement total budget,DRG is considered to be more delicate payment system design.Because of Beijing medical insurance fund control cost pressure ratio Shanghai small,therefore,The personage inside course of study often put Beijing by the DRG model and total in advance as the main body of the Shanghai model for comparison/research.

　　所谓按疾病诊断相关分组付费，即先参考患者的年龄、疾病诊断等多个因素，将疾病分入若干诊断组；然后，医院与保险机构通过谈判合理确定各疾病诊断组的付费标准，保险机构按此协定的标准向医院支付费用。

The so-called by the disease diagnosis related pay packet,The first reference of the patient's age/Disease diagnosis, and other factors,Will the disease points into several diagnosis group;then,The hospital and insurance institutions through the negotiation reasonably determine the various disease diagnosis group of pay rate,Insurance institutions according to the agreement to pay the standard of hospital.

　　不过，在北京力推总额预付之后，DRG的试点进度已经放缓。

but,In Beijing after total push in advance,The DRG pilot progress has been slow.

　　9月20日，北京市一位参与了DRG试点方案设计的知情人士告诉《中国新闻周刊》，“目前试点病例刚刚达到一万，在3月底的时候，6家试点医院的‘盈余’比例在18%左右，目前已经下降到了15%，“说明我们当初制定的额度比较合理”。

On September 20th,Beijing a participated in the DRG pilot scheme design source told[China news weekly],"At present pilot case just reached ten thousand,When in the end of march,Six pilot hospital‘surplus’The proportion of 18%,At present has dropped to 15%,"We had that formulated by the reasonable limit".

　　按照原有计划，6家医院的DRG试点将从最初的108个病组种推广至605个病组，不过，“6家医院试点还在继续，但是很难进一步推开了，医保方面不看好这个。”知情人士表示。

According to the original plan,Six hospital DRG pilot will from the initial 108 disease group kind of promotion to 605 disease group,but,"6 hospitals pilot continues,But it is difficult to further pushed away,Health care not banking on this."People familiar with the matter say.

　　蒋继元亦在前述场合称，在对总额预付进行大力推广的同时，对于DRG付费的改革试点，目前正在进行阶段性总结，“下一步再稳妥推进”。北京市人力与社会保障局副巡视员蒋继元告诉《中国新闻周刊》，推行DRG，需要大量的人力支持以及强大的技术环境。

JiangJiYuan also in the occasions that,In the total advance vigorous promotion at the same time,For the DRG paying reform pilot,At present are summarized periodically,"The next step to safely ahead".Beijing human and social security bureau deputy inspector JiangJiYuan tell[China news weekly],Implementation of DRG,Need a lot of manpower support and powerful technology environment.

　　然而，在知情人士看来，稳妥推进很有可能就意味着，试点推进不会像之前预想的那样快了。

however,People familiar with the matter seems in,Safely ahead very likely means,Pilot propulsion will not be as previously thought that fast.

　　北京大学附属人民医院(以下简称北大人民医院)院长王杉在今年3月底接受《中国新闻周刊》采访时说，DRG是个精细活。北大人民医院为试点所做的准备工作历时三年，非常繁琐，比如，首先需要规范疾病诊断和病案首页，建立智能化的辅助系统；建立学习型临床路径管理应用系统；建立医疗质量评价和监测保障系统；建立与科室收支结余脱钩的关键绩效指标考核体系等等。北大人民医院花了三年时间，失败了3次，才最终完成了临床路径管理应用系统的建设。

Beijing university people's hospital affiliated(Hereinafter referred to as the people's hospital of Peking University)In the end of march of this year WangSha accept[China news weekly]interview,DRG is a fine living.Peking University people's hospital for pilot's preparation over three years,Very tedious,For example,First of all need to regulate disease diagnosis and medical record home page,Establish intelligent auxiliary system;Establish learning clinical pathway management application system;Establish the medical quality evaluation and monitoring system;Establishment and department your balance decoupling of the key performance index evaluation system, etc.Peking University people's hospital spent three years time,Failed three times,Finally completed the clinical pathway management application system construction.

　　此外，在DRG试点推开后，医院还面临较大的控费压力。因此，如何在前端推动医护人员改变过度诊疗的习惯，成为必要的措施。

In addition,In DRG pilot after push,The hospital is confronted with control cost pressure.therefore,How to promote the medical staff at the front change the habit of excessive diagnosis and treatment,Become the necessary measures.

　　目前，北大人民医院的办法是，把科室的收支结余与医护人员的奖金脱钩。在传统的按项目收费模式下，项目越多药费越多，医院收入越多，科室结余越多，医护人员多开药、多检查、过度诊疗的情况屡禁不止。薪酬改革之后，医护人员奖金和其提供的医疗服务数量以及质量挂钩，内科医护人员主要考量总出院人数和主要疾病病人(危重病人)出院人数，而外科的考核是总手术人数和主要手术(疑难危重手术)例数等。

At present,Peking University people's hospital method is,The departments of your balance and medical personnel bonus decoupling.In the traditional item charge mode,The more the more medicine project,Hospital income more,Department the more balance,Medical staff prescribe more/check/Excessive diagnosis and treatment situation repeatedly endures more than.Salary after reform,Medical staff bonuses and its medical service quantity and quality hook,Medical staff major considerations total discharge toll and the main disease patients(Critically ill patients)Discharge toll,And surgical assessment is the number of total operation and main operation(Difficult critically ill surgery)Number, etc.

　　更严峻的挑战还要来自于DRG改革后，要求医保部门监管能力也需同步提升。上述知情人士认为，推行DRG需要医保部门引进足够多的医学专业人员。“这些人员不但要有深厚的医学背景，还要有病案知识等，确实对医保部门是个考验。但让医保部门扩大编制也比较难。”上述人士说。

Even more severe challenges from the DRG after reform,Medical insurance department for the supervisory ability of the ascending simultaneously also needs.People familiar with the above that,Implementation of the DRG need medical insurance department introduce enough medical professionals."These personnel should not only have profound medical background,Have medical knowledge, etc,Indeed for health care providers is a test.But let health care providers to expand establishment also more difficult."The above said people.

　　与复杂的DRG相比，总额预付的计算方式相对简单，对医保部门的监管能力要求相对较低。但是，总额预算的费用标准到底如何制定，同样是摆在医保部门面前的难题。

Compared with complex DRG,The calculation of total advance relatively simple way,To the oversight of the department of medical insurance ability request is relatively low.but,The cost of the total budget standard exactly how to develop,Is also the problem of medical insurance department in front.

　　总额预付是通过对参保人数、年均接诊总人次数、次均接诊费用水平等数据，测算医疗费用支付总额，由医保机构定期预拨，实行总额控制、包干使用、超支分担的支付方式。其前提之一是，对相关数据进行相对准确的测算。

The total advance is based on the number of ginseng/Annual average accepts the total number of people/Second all accepts cost level data, etc,Measure the total medical treatment charge pays,The medical insurance institution with a regular,Implement total amount control/Lump sum use/Overspend share payment.Its premise is one of,The relevant data relative accurate measure.

　　但是，由于目前患者的流动性比较大，医院和患者之间不存在稳定的就诊关系，导致成本的准确核算和风险的精细测算难以成行，“这就导致总额预付可能会粗线条，不够精细，”上海申康医院发展中心副主任、复旦大学医院研究所所长高解春说。

but,Because the present patients more liquidity,The hospital and patient does not exist between a stable relationship,Lead to cost accounting and accurate risk fine measurement is difficult to go,"This will lead to the total advance may be rough and ready,Not fine,"Shanghai shen-kang hospital development, deputy director of the center/Fudan university hospital institute director high XieChun said.

　　部分医疗机构负责人对总额预付也有疑虑。北京市一家三甲医院的副院长日前向《中国新闻周刊》表达了他的疑虑：“最担心的是政府给的钱够不够花。此外，总额预付似乎只控费，不考虑医疗质量，这个不该改进吗？”

Part of the medical institutions to advance the total also have doubts.Beijing a 3 armour hospital deputy director has to[China news weekly]Expressed his doubts:"Most worried about is the government give had enough money to spend.In addition,The total advance seem only control fee,Don't consider the quality of medical treatment,This shouldn't be improved?"

　　上述三甲医院副院长的担心并非多余，在总额预付的支付方式下，医院还有可能会推诿危重病人，因为此类病人耗费医保基金较多。今年4月，推行了总额预付制的河北保定一些医院，为了避免医保“超了”，对于一些职工医保病人，要么拒收，要么要求患者自费。据悉，上海也出现过类似现象。

The above 3 armour hospital deputy director of worry is not excess,In the total advance payment mode,The hospital and may balk critically ill patients,For such patients medical insurance fund cost more.In April this year,Implementation of the total sum of prepaid system of hebei baoding some hospitals,In order to avoid medical insurance"super",For some worker health care patients,Or rejection,Either request the patient at one's own expense.It is reported,Shanghai also has had the similar phenomenon.

　　

弹性改良 Elastic improved

　　在推广总额预付制度同时，北京、上海两地也对总额预付制度进行了一些调整，以便调动医院方面的积极性。

In the promotion of the total advance system at the same time,Beijing/Shanghai to both the total advance system made some adjustments,In order to mobilize the enthusiasm of the hospital aspects.

　　在上海版的改革方案中，如果医院控费成效显著，年初的预算总额没有花完，结余部分可以由医院留用，而以前则是直接划归医保部门。

In Shanghai version of the reform scheme,If the hospital control FeiChengXiao significantly,At the beginning of the year the total budget didn't take out,Balance part can continue to employ by the hospital,And before is directly put under medical insurance department.

　　对于医保支付的超额部分，北京也规定了医保基金和试点医院按一定比例分担。具体的分担比例分为两档：超额在10%以内，试点医院支付8%；超额在10%以上，试点医院支付15%。比如，以同仁医院为例，其2011年超额的比例是4.23%，在10%以内，医院承担的就是这超额部分的8%。

For the medical insurance payment of the excess part,Beijing also has stipulated the medical insurance fund and pilot hospital according to a certain proportion to share.Specific the allocation proportion is divided into two gears:Excess in 10% less than,Pilot hospitals pay 8%;Excess in more than 10%,Pilot hospitals pay 15%.For example,In tongren hospital as an example,Its 2011 excess proportion is 4.23%,Within 10%,Hospital bear is this excess part of 8%.

　　此外，就北京而言，考虑到价格等因素，试点医院2012年的总额预算费用每年都会有所上调，比如，友谊医院和同仁医院2012的总额预算计划额度都比去年增加了10%。不过，这个10%的增幅并非固定不变，要根据医保基金的筹资情况等因素具体确定。

In addition,In Beijing,Considering the factors such as price,Pilot hospital in 2012 the total amount of the cost budget every year to increase,For example,Friendship hospital and tongren hospital 2012 total budget quota is about a 10% increase over last year.but,The growth of 10% is not fixed,According to the medical insurance fund financing situation factors is specific and affirmatory.

　　据北京同仁医院院长伍冀湘透露，考虑到2012年该院接诊的患者数量和提供的医疗服务数量有所增加，目前，相关部门准备在年初计划额度的基础上，给该院再增加一些额度。

According to the Beijing tongren hospital dean WuJiXiang revealed,Considering the 2012 patients with hospital accepts the quantity and the medical service quantity increase,At present,The relevant departments in the beginning of the year to plan based on the line,The hospital to add some limit.

　　伍冀湘说，目前医疗机构、医保部门等达成了一个共识，“就是说只要是达到了次均费用的降低，政府会考虑到医院额外增长的工作量，因为各个医院住院病人、门急诊都在增加，这个自然的增加量政府是会补给医院，前提是医院得把次均费用控制住了”。

WuJiXiang said,At present medical institutions/Health care providers and reached a consensus,"That is as long as it is to reduce the cost of all time,The government will consider to the hospital the growth of extra workload,Because each hospital patients/This is on the increase,The natural increase in government will supply the hospital,Premise is the hospital have to second all cost control".

　　在上海，每年9月，医保部门也会针对医院运行中出现的特殊情况，利用机动预算对年初定额作出调整，这在一定程度上缓解了医院的超额风险。

In Shanghai,Each year on September,Medical insurance department in hospital operation will also appear in the special situation,Use of motor to adjust the budget quota at the beginning,This, to a certain extent, ease the hospital excess risk.

　　考虑部门内缺乏专业技术人员， 2008年，上海市医保部门引入了院长协商机制，事实上把医保总额的分配权从医保部门部分地移交给院长协调小组。据《健康报》披露，每年4月前后，上海医疗机构开始分切医保基金“蛋糕”，上海市医保办组织召开医院代表会议进行自主协商，第一轮先将下一年度的医院预算总额划分为三级医院和一二级医院预算总额，第二轮协商确定三级医院预算总额分配方案以及各区县医保总额分配方案，第三轮协商确定各区县内一二级医院的总额分配方案。

Considering the lack of professional and technical personnel in the department, In 2008,,The Shanghai medical insurance department introduced dean consultation mechanism,In fact the medical insurance of the total amount of the distribution of medical insurance department from part over to dean coordination group.According to[health]disclosure,April every year before and after,Shanghai medical institutions start cutting the medical insurance fund"cake",The Shanghai medical insurance organization do a hospital representative meeting independent consultation,The first round to next year's hospital total budget is divided into tertiary hospital and the hospital total 12 budget,The second round of affirmatory tertiary hospital total budget allocation scheme and the total area county medical insurance scheme,The third round of consultation to determine the county hospital district 12 total amount allocation scheme.

　　尽管上海的总额预付已经全面推开，控费效果也有所显现。不过，一些医疗机构人士仍然更看好更为精细的DRG。在复旦大学医院研究所所长高解春看来，如果医保付费改革的目标仅仅是控费，先实施能在短期内奏效的总额预付就是更稳健的选择，但长期来看，总额预付更易导致医生行为扭曲，比如推诿危重病人，降低医疗服务质量等等。

Although the total amount of Shanghai in advance has been comprehensively push away,Control fee effect will be revealed.but,Some medical institutions people still prefer more delicate DRG.In fudan university hospital institute director high XieChun looks,If medical insurance pay reform goal is only control fee,First can implement in the short term the total amount of work in advance is the choice of more robust,But in the long term,The total advance are more likely to lead to the doctor behavior distortion,Such as shadowboxing critically ill patients,Reduce the medical service quality, etc.

　　也许正是意识到这一点，京沪两地目前都是多种支付方式并存。比如，北京逐步形成了单病种、按床/日、定额付费、总额预付和DRG以及总量控制下的按项目付费等多种形式并存的医保基金支付方式。“上海模式”同样是多种支付方式并存的混合支付模式。除了占据主体地位的总额预付模式之外，上海还实施了精神病住院费用按床日付费和17个住院病种按病种付费的支付方式等。

Perhaps it is aware of this,Just two at present are multiple payment means to coexist.For example,Beijing gradually formed a single disease/According to the bed/day/Quota pay/The total advance and DRG and under the control of total amount according to project a variety of forms such as pay for both the medical insurance fund payment."Shanghai mode"Is also a variety of payment of coexistence mixed payment mode.In addition to occupy the main body status of the total advance beyond mode,Shanghai also implemented a psychiatric hospital fees on a bed, pay and 17 hospital disease press disease to pay payment, etc.

　　中国医疗保险研究会一位专家告诉《中国新闻周刊》，每种支付方式都各有利弊，“现在的情况下，要多试点，多总结，不可能一蹴而就”。 ★

Chinese medical insurance research an expert to tell[China news weekly],Each payment are each have advantages and disadvantages,"This situation,The pilot to,Many summary,Can't accomplish in one move". painted