关键词: 医联体, 医保支付, 卫生保健改革, 重庆

Abstract: Medical consortium is an important part of medical reform，and medical insurance payment reform is a major endogenous driving force of medical consortium reform.But the development of the two is not well coordinated，resulting in decreased effect of health insurance programs in promoting initial consultation in primary care，and lack of dynamic cooperation mechanism between the institutions within a medical consortium.Analysis the status of medical consortiums，and the medical insurance payment modes in Chongqing.Points out the existing problems of medical insurance payment in Chongqing medical association，puts forward the reform strategy of medical insurance payment suitable for Chongqing medical association，and provides policy suggestions for the improvement of medical association.The interview results showed that Chongqing has established three modes of medical consortiums（trustee model，branch mode and county technical assistance mode），pooled health insurance funds from the municipal government agencies successfully，established mixed medical insurance payment modes，and reduced the threshold for using medical insurance payment for those transfered treatment.However，many problems are needed to be solved，such as medical insurance funds can not be mobilized from the institution with a surplus to that with a deficit within the medical consortium，lack of linkage between the medical consortium and medical insurance payment，the imperfect payment mode of medical insurance，and lack of corresponding performance appraisal methods.In view of this，we put forward the following suggestions：building a compact type of medical consortium，allowing the appropriate mobilization of the medical insurance funds from an institution with a surplus to that with a deficit within the medical consortium，improving the healthcare quality and performance appraisal system and incentive and restraint mechanisms for healthcare providers，formulating relevant medical insurance policies if needed，rationally determining the total budget for medical insurance programs，and improving the payment modes of medical insurance.All these contribute to the exploration of new modes of medical insurance payment reform，and of policy recommendations for the development of medical consortium at the national level.

Key words: Medical integration model, Medical insurance payment, Health care reform, Chongqing