论我国农村医疗机构按病种付费可行性模式构建  

Study on the Feasible Model of the Payment of Specific Diseases in the Rural Medical Institutions of Our Country

作　　者：姚岚[1] 聂春雷[2] 刘运国[3] 刘华林 罗奎 

机构地区：[1]华中科技大学同济医学院医药卫生管理学院,湖北武汉430030 [2]卫生部农村卫生管理司,北京100044 [3]卫生部国外贷款办公室,北京100009 [4]镇安县卫生局,陕西镇安711500 [5]重庆市黔江区卫生局,重庆409000

出　　处：《中国医院管理》2007年第7期19-21,共3页Chinese Hospital Management

基　　金：卫生部国外贷款办公室农村卫生政策应用研究课题(H8SP-OR-20)

摘　　要：通过研究提出我国农村医疗机构按病种付费可行性模式。模式以单病种定额付费为主,限额付费为辅,实行总额预算控制;按照本地住院人次的疾病顺位,选择前10～15位的疾病作为单病种,并通过标化平均费用法或加权平均费用法制订定额标准,同时由行业监管和非行业监管进行质量监控。模式在管理上有4个要点:诊疗常规药品比例控制、医疗专业技术委员会、当场减免的报销方式和完善信息系统。其外部条件为政府的支持、乡镇卫生院建设、配套卫生改革、县级医疗机构之间形成竞争。The feasibile model of the payment of specific diseases for the rural medical institutions in China is raised by our research group.Quota fees for the specific-disease is the main part of the model, limitation fees is the minor part to control the total budget, and global budget is carried out at the sametime.The first 10-15 places at the diseases list are selected as specific-disease according to the person-times of the in-patients.The quota criterion is formulated by standardization average expenditure Or weighted average expenditure.The quality monitoring and control is conducted by industry monitoring and un-industry monitoring.Four key points of the model in management are the control of regular drug proportion in treatment, founding the medical specialized technical committee, the recouping way, perfecting the information system;The external conditions are the support from government, the construction of Township Health Centers, the supplementary rural health policies and the competition between medical institutions at county level.

关 键 词：农村医疗机构 按病种付费 模式 

分 类 号：R197.1[医药卫生—卫生事业管理]