基本医疗保险按病种付费核心要点研究
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摘要
系统梳理我国历年来各统筹地区按病种付费的实践经验,结合实地调研,总结按病种付费的核心要点,包括病种范围与医疗类别选择、病种付费标准的测定、费用结算办法的制定三个方面,最终提出因地制宜制定按病种付费工作方案,加大参保患者自费费用控制,多维度合理测定付费标准等政策建议。
Based on the practical experience of DRGs in various areas in China over the years and field research,this paper summarized core points of DRGs,including the scope of disease types and medical category selection,the measurement of disease-type payment standards,and the formulation of cost settlement methods. China should set DRGs according to local conditions,increase the control of self-funded expenses for insured patients,and evaluate the reason-ability of payment standard multi-dimensionally.
Based on the practical experience of DRGs in various areas in China over the years and field research,this paper summarized core points of DRGs,including the scope of disease types and medical category selection,the measurement of disease-type payment standards,and the formulation of cost settlement methods. China should set DRGs according to local conditions,increase the control of self-funded expenses for insured patients,and evaluate the reason-ability of payment standard multi-dimensionally.
引文
[1]薛迪.按病种付费的发展和管理关键点[J].中国卫生资源,2018(1):27-31.
[2]宋斐斐,赵坤元,申俊龙.临床路径在单病种付费中的应用研究进展[J].中国医药导报,2016,13(3):163-165.
[3]江苏省政府办公厅.省政府办公厅关于进一步深化基本医疗保险支付方式改革的实施意见[EB/OL]. http://www.jiangsu.gov.cn/art/2018/2/27/art_46144_7495850.html.
[4]广州市人力资源和社会保障局.广州市社会医疗保险住院医疗费用按病种分值付费工作的通知[EB/OL]. http://www.hrssgz.gov.cn/zcfg/shbxyzgfl/201801/t20180105_273659.htm.
[2]宋斐斐,赵坤元,申俊龙.临床路径在单病种付费中的应用研究进展[J].中国医药导报,2016,13(3):163-165.
[3]江苏省政府办公厅.省政府办公厅关于进一步深化基本医疗保险支付方式改革的实施意见[EB/OL]. http://www.jiangsu.gov.cn/art/2018/2/27/art_46144_7495850.html.
[4]广州市人力资源和社会保障局.广州市社会医疗保险住院医疗费用按病种分值付费工作的通知[EB/OL]. http://www.hrssgz.gov.cn/zcfg/shbxyzgfl/201801/t20180105_273659.htm.