实行按病种分值付费制度的实践经验及启示  

Enlightens from Practice of Disease-Based Score Payment

作　　者：陈曼莉[1] 赵斌[2] 

机构地区：[1]湖北中医药大学管理学院,武汉4300652 [2]人力资源和社会保障部社会保障研究所,所北京100029

出　　处：《中国卫生经济》2017年第6期38-41,共4页Chinese Health Economics

基　　金：湖北省教育厅科学技术研究计划优秀中青年人才项目(Q20121604)

摘　　要：以淮安市和南昌市两地的按病种分值付费方案设计为例,分析其构成和内容。按病种分值付费将总额控制、点数法和按病种付费三种结算方式结合起来,既能控制费用,又能促进激励作用,在实践地区收到了效果。调研发现在实施中仍存在不足,其推广的前提条件是要具备较高的医保经办能力,建立与医疗机构的谈判机制,还要有智能化的信息系统做技术支撑。It analyzed the structure and details of disease-based score payment, taking payment policy scheme in Jiao-an and Nan-chang for example. Disease-based score payment combined the globe budget control, payment of disease and point system to help controlling costs and incentive mechanism, which bad certain achievement in the pilot areas. According to the research, it found that there were insuffic, ient in the practical implementation, proposed the precondition for the popularization were higher medical agency capacity, estab-lishing the negotiation mechanism with medical instilutions and having intelligentized information system as the technical support.

关 键 词：按病种分值付费 支付方式改革 基本医疗保险 

分 类 号：R197.1[医药卫生—卫生事业管理]