宁夏某三甲医院按病种分值付费和按病种收付费实施现状研究
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摘要
为贯彻落实自治区医疗保险付费制度,探索医保付费新举措,笔者对宁夏某三甲医院按病种分值付费和按病种收付费的实施现状进行分析,主要从付费制度基本情况、医院主要做法、实施效果三个方面详细介绍,最后从科学制定付费制度、加强部门沟通协作、提升医院内部管理、完善信息化建设深入思考,旨在从医疗机构的视角为国家医保付费政策提供参考意见,提高医保基金的使用效率,控制医保费用不合理增长,提高医疗服务质量,更好地平衡医、保、患三方利益。
In order to implement the medical insurance payment system in the autonomous region and explore new measures for medical insurance payment,the implementation status of payment by disease scores and paying by disease types in grade 3 A hospital in Ningxia was analyzed,it was mainly introduced from the basic situation of the payment system,the main practices of the hospital,and the implementation effects. Finally,the author thinks deeply about making payment system scientifically,strengthening department communication and cooperation,improving hospital internal management and improving information construction. From the perspective of medical institutions to provide a reference for thecountry medical insurance payment policy,improve the efficiency of using health insurance funds,control the unreasonable growth of medical insurance expenses,improve the quality of medical services,and ensure the tripartite wins of hospitals,healthcare patients and the authorities of medical insurance.
In order to implement the medical insurance payment system in the autonomous region and explore new measures for medical insurance payment,the implementation status of payment by disease scores and paying by disease types in grade 3 A hospital in Ningxia was analyzed,it was mainly introduced from the basic situation of the payment system,the main practices of the hospital,and the implementation effects. Finally,the author thinks deeply about making payment system scientifically,strengthening department communication and cooperation,improving hospital internal management and improving information construction. From the perspective of medical institutions to provide a reference for thecountry medical insurance payment policy,improve the efficiency of using health insurance funds,control the unreasonable growth of medical insurance expenses,improve the quality of medical services,and ensure the tripartite wins of hospitals,healthcare patients and the authorities of medical insurance.
引文
[1]李锦汤,张艳纯,李劲佩.广东全面开展按病种分值付费的进程和初步成效[J].中国医疗保险,2018(4):44-46.
[2]尚文刚.新形势下医院医疗保险精细化管理实践[J].现代医院,2017,17(6):781-783.
[3]冯帅,史录文.我国医疗服务按病种收付费试点工作现状分析[J].中国药房,2012,23(5):385-387.
[4]张博,刘涛,龚福玲.总额控制下的按病种分值付费评价—基于银川市的实践[J].中国医疗保险,2016(7):35-38.
[5]赵云.按病种收费方式与按病种付费方式比较[J].中国卫生事业管理,2013,30(11):808-811.
[6]徐伟,郝梅,杜珍珍.总额控制下按病种分值付费的实践与思考[J].中国药房,2016,27(6):721-723.
[7]徐海英,黄洁仪,陈丹心,等.病种分值付费的政策性思考[J].现代医院,2018,18(6):842-844,850.
[8]邓倩,李东华,肖黎,等.我国基本医疗保险总额控制下的按病种分值付费现状研究[J].医学与社会,2016,29(9):11-13.
[9]邹伏英,熊瑶,邹俐爱,等.按病种收(付)费相关规范研究探讨[J].中国卫生事业管理,2017,34(8):589-592.
[10]张明敏.城镇职工医保住院费用按病种分值结算探析[J].中国医疗保险,2016(1):51-53.
[11]陈曼莉,赵斌.实行按病种分值付费制度的实践经验及启示[J].中国卫生经济,2017,36(6):38-41.
[2]尚文刚.新形势下医院医疗保险精细化管理实践[J].现代医院,2017,17(6):781-783.
[3]冯帅,史录文.我国医疗服务按病种收付费试点工作现状分析[J].中国药房,2012,23(5):385-387.
[4]张博,刘涛,龚福玲.总额控制下的按病种分值付费评价—基于银川市的实践[J].中国医疗保险,2016(7):35-38.
[5]赵云.按病种收费方式与按病种付费方式比较[J].中国卫生事业管理,2013,30(11):808-811.
[6]徐伟,郝梅,杜珍珍.总额控制下按病种分值付费的实践与思考[J].中国药房,2016,27(6):721-723.
[7]徐海英,黄洁仪,陈丹心,等.病种分值付费的政策性思考[J].现代医院,2018,18(6):842-844,850.
[8]邓倩,李东华,肖黎,等.我国基本医疗保险总额控制下的按病种分值付费现状研究[J].医学与社会,2016,29(9):11-13.
[9]邹伏英,熊瑶,邹俐爱,等.按病种收(付)费相关规范研究探讨[J].中国卫生事业管理,2017,34(8):589-592.
[10]张明敏.城镇职工医保住院费用按病种分值结算探析[J].中国医疗保险,2016(1):51-53.
[11]陈曼莉,赵斌.实行按病种分值付费制度的实践经验及启示[J].中国卫生经济,2017,36(6):38-41.