保险学-“互联网+”医保支付制度的改革研究论文

“互联网+”医保支付制度改革研究——以珠三角为例【摘要】医疗行业进军入“互联网+”医疗平台，打开了全新的“互联网+”医疗时代。而后是“互联网+”医疗健康方案的推行，对深化医改提出新要求。于“互联网+”医疗这个全新的局面，“互联网+”医疗医保支付制度还未能达到三医联动的阶段。首先是目前“互联网+”医疗只支持部分医疗项目进行医保个人账户报销，还未制定相关完善的医保付费方式和医保计算公式以及基金结算办法。其次是如何将“互联网+”医疗医保管理融入医疗服务的全过程管理，平衡“互联网+”医疗医保费用与医疗服务，监管无盲区。另外是如何借助互联网技术发展医保制度的绩效评价系统，不断深化改革“互联网+”医疗医保支付制度的不足。本文基于珠三角地区互联网医院，主要从“互联网+”医疗医保技术层面的付费方式、管理层面的过程管控和效果层面的绩效评估三个方面着手研究，综合相关医保政策，以及相关资讯和文献，分析互联网医院的医保支付制度改革中有哪些不足之处，提出有效的相应解决措施，这对推进珠三角互联网医疗事业的发展具有重大意义。【关键词】“互联网+”；医保支付制度；互联网医院 注：本论文（设计）题目来源于教师的国家级（或省部级、厅级、市级、校级、企业）科研项目，项目编号为：B2019233 Research on the Reform of Medical Insurance Payment System under Internet plus Medical Care——Taking the Pearl River Delta as an Example [Abstract] The medical industry entered the Internet plus medical platform and opened a brand-new Internet plus medical era. Then came the implementation of the Internet plus medical and health plan, which put forward new requirements for deepening medical reform. In the new situation of Internet plus medical care, the Internet plus medical insurance payment system has not yet reached the stage of linkage between the three doctors.The first is that at present, Internet plus medical care only supports some medical projects for reimbursement of individual medical insurance accounts, and has not yet formulated relevant perfect medical insurance payment methods, medical insurance...