“单病种付费制”对医院的影响  

Influence of Single-disease Payment System to Hospital

作　　者：杨月艳[1] 季亚男[1] 张蓉虹[1] 仲珽 吴雨娴 Yang Yueyan;Ji Yanan;Zhang Ronghong;Zhong Ting;Wu Yuxian(Medical Insurance Office,Hospital of TCM in Jiangsu Province,Jiangsu Nanjing 210029)

机构地区：[1]江苏省中医院医保办公室,江苏南京210029

出　　处：《江苏卫生事业管理》2018年第4期416-418,共3页Jiangsu Health System Management

摘　　要：目的:医疗保险逐步推行"单病种付费制"。研究单病种管理规范诊疗,控制不合理费用,为付费提供科学合理的标准,实现由传统的结果评价转变到过程评价。方法:理想的单病种费用"上限"设定应是确保医疗质量基础上,以循证医学为基础的临床路径为依据,运用疾病诊断相关组(DRGs)方法体现成本消耗的费用测定。结论:该院实施单病种管理一年来,客观上在保证医疗质量的前提下,提高了医院的运行效率,减轻了患者的经济负担。但由于病情的多样性及药品、耗材等不可控因素的影响,也发现了一定的问题。Objective:Medical insurance agencies are gradually implementing the“single-disease payment system”.Studying the rules of diagnosis and treatment of single-disease management,to control unreasonable costs,provide reasonable and scientific standards for payment,and change the traditional result evaluation to process evaluation.Methods:The ideal“upper limit”for the cost of the single diseases should be a cost-benefit measure that reflects the cost-savings based on the evidence-based clinical pathways and DRGs which guarantee medical quality.Conclusion:In the past one year,since the implementation of single-disease management in our hospital,objectively,not only ensuring the quality of medical treatment,raising efficiency of the hospital,lighting the economic burden on patients.However,because the diversity of diseases and the influence of uncontrollable factors such as medicines and consumables,some problems have also been found.

关 键 词：单病种付费 单病种管理 临床路径 疾病诊断相关组 

分 类 号：R197.3[医药卫生—卫生事业管理]