基本医疗保险按病种付费核心要点研究  

Research on the Core Points of Basic Medical Insurance Payment by Disease

作　　者：李孟林 徐伟[1] LI Meng-lin;XU Wei(International Pharmaceutical Business School of China Pharmaceutical University,Nanjing Jiangsu 210098,China)

机构地区：[1]中国药科大学国际医药商学院,江苏南京210098

出　　处：《卫生经济研究》2019年第3期44-46,共3页

摘　　要：系统梳理我国历年来各统筹地区按病种付费的实践经验,结合实地调研,总结按病种付费的核心要点,包括病种范围与医疗类别选择、病种付费标准的测定、费用结算办法的制定三个方面,最终提出因地制宜制定按病种付费工作方案,加大参保患者自费费用控制,多维度合理测定付费标准等政策建议。Based on the practical experience of DRGs in various areas in China over the years and field research,this paper summarized core points of DRGs,including the scope of disease types and medical category selection,the measurement of disease-type payment standards,and the formulation of cost settlement methods. China should set DRGs according to local conditions,increase the control of self-funded expenses for insured patients,and evaluate the reason-ability of payment standard multi-dimensionally.

关 键 词：按病种付费 单病种 病种范围 付费标准 结算办法 

分 类 号：R19[医药卫生—卫生事业管理]