以膀胱癌为例探讨医保单病种付费方式对医疗服务质量的影响  

Analysis on the influence of single-disease payment method on medical service quality： bladder cancer as an example

作　　者：付子英 井琨 王军[1] 

机构地区：[1]天津医科大学第二医院医保科,300211

出　　处：《中华医院管理杂志》2017年第12期893-896,共4页Chinese Journal of Hospital Administration

摘　　要：目的探讨天津市多家三级医院开展医保单病种付费方式后，对医疗服务质量所产生的影响。方法采用回顾性分析和满意度调查问卷相结合的方式，剔除不符合研究标准的病例后，共选取天津市5家三级医院2015年1月至2017年5月的膀胱癌病例1035例，其中政策实施前采用普通医保结算方式者522例，政策实施后进入单病种的病例513例；从两组中各选择300例患者，128名主管医生，向其发放满意度调查问卷。结果采用单病种付费方式后住院天数缩短1．27天，人均住院医疗费发生额下降1237元，患者自付金额平均下降3890元，拒付金额平均下降11元，患者和医生的满意度均有不同程度的提升，差异均有统计学意义（均P〈0．05）。结论单病种付费方式控费效果明显，对医疗服务质量有一定的积极影响。Objective To analyze the impact of medical service quality after single-disease payment method was in place at a number of tertiary hospitals in Tianjin. Methods Retrospective analysis and satisfaction questionnaire were used to choose 1 035 cases of bladder cancer from January 2015 to May 2017, consisting of 522 cases settled in conventional medical insurance payment prior to the reform, and 513 cases settled in the single-disease payment. 300 patients were selected from each type plus 128 doctors, for satisfaction questionnaire survey. Results The single-disease payment method, since in place, had cut back the average days of stay by 1.27 days, per-capita inpatient medical expenses by 1 237 yuan, average out-of-pocket payment by 3 890 yuan, and the non-payment amount by 11 yuan. Both patients and doctors were more satisfied than before to a different extent, with the difference statistically significant （P 〈 0.05）. Conclusions Single-disease payment method can control the cost obviously, thus conducive to the quality of medical services.

关 键 词：单病种付费 医保 医疗服务质量 膀胱癌 

分 类 号：R197.32[医药卫生—卫生事业管理]