新型农村合作医疗保险按病种付费支付方式改革的思考  

Ideas of Diagnosis-Related Groups in payment reform for the New Rural Cooperative Medical System in rural China

作　　者：孙梅[1] 李程跃[2] 苌凤水[1] 陈文[3] 林尚立[4] 郝模[1] 

机构地区：[1]复旦大学卫生发展战略研究中心,上海200032 [2]复旦大学公共管理与公共政策研究创新基地,上海200433 [3]复旦大学公共卫生学院,上海200032 [4]复旦大学国际关系与公共事务学院,上海200433

出　　处：《中国卫生资源》2013年第5期309-311,共3页Chinese Health Resources

基　　金：教育部重大攻关项目(07JZD0017);国家自然科学基金项目(70733002;71003025);教育部创新团队项目(IRT0912);复旦大学"复旦工程"三期整体推进社会科学研究项目(2011SHKXZD020;2012SHKXQN008);上海市卫生局卫生政策研究课题(2011HP002)

摘　　要：以华东某地的实际住院数据为例,针对卫农卫发[2012]36号文件关于新农合支付方式改革中的按病种付费方式进行了分析与探讨。分析发现,36号文中规定的20类重大疾病实际就医比例低,医疗费用离散程度大,不适合作为改革的先行试点病种;而白内障、子宫肌瘤、阑尾炎等发生频率高、费用集中趋势好、临床路径清晰的常见病种,可考虑作为先行试点病种。另外,要实现真正意义的"按病种"付费,还需要规范信息化建设,科学测算支付标准,选择付费模式,以及设置对医疗机构及需方的监控考核指标体系等后续步骤及措施的配套实现。This paper analyzed and discussed Diagnosis Related Groups（DRGs）in payment reform for the New Rural Cooperative Medical System（NRCMS）.Inpatients data of a certain area in East China was taken as an example.The main results were as follows：rural residents with 20 critical illness mentioned in the relative governmental document（Department of Rural Health Management,MOH,[2012]No.36）had a low proportion of medical treatments,and their medical expenses were of great dispersion degree,therefore,these illness were unsuitable to be the prior pilot illness in payment reform;In contrary,illnesses with high incidence,centralized medical expenses and clear clinical path,such as cataract,hysteromyoma,appendicitis,could better be on the list.Then some following procedures and measures were quite necessary to conduct DRGs in its true sense,such as standardization of information construction,scientific measurement of payment standard,selection of payment mode and establishment of supervision and appraisal systems for providers and demanders.

关 键 词：新型农村合作医疗 支付方式 按病种付费 

分 类 号：R197.1[医药卫生—卫生事业管理]