收付费双轨制改革对医院财务管理的影响  

The Impact of the Dual-track Reform of Payment on Hospital Financial Management

作　　者：高菁 崔斌[1] 朱兆芳 冯文[1] GAO Jing;CUI Bin;ZHU Zhao-fang;FENG Wen(School of Public Health,Peking University School of Medicine,Beijing 100191,China)

机构地区：[1]北京大学医学部公共卫生学院,北京100191 [2]国家卫生健康委卫生发展研究中心,北京100044

出　　处：《卫生经济研究》2019年第9期68-71,共4页

基　　金：国家卫生健康委基层司新农合支付方式联系点项目（2209121）

摘　　要：目的:评估医保基金端与患者端两种支付方式的双轨制管理对医院财务管理的影响。方法:调取2017年7月至2018年6月陕西省榆林市两家试点医院非单病种新农合住院患者医疗费用结算数据,分析比较各病组收付费差额情况。结果:结余主要集中在低费用病组,中等费用病组对结余的贡献较大;亏损主要存在于高费用病组。结论:收付费双轨制淡化了支付方式改革对医院的压力;DRG的财务风险主要集中在高费用病组;低费用病组贡献收益可能导致医院选择轻症患者;“三保合一”有利于医院收付费并轨。Objective To evaluate the impact of the dual-track management of medical insurance fund end and patient end payment methods on hospital financial management.Methods The medical expenses settlement data of non-single disease of new rural cooperative hospitalized patients in two pilot hospitals in Yulin City,Shaanxi Province from July 2017 to June 2018 were collected.Results The balance was mainly concentrated in the low-cost disease group and the intermediate-cost disease group contributed great to the balance;the loss mainly existed in the high-cost disease group.Conclusion The dual-track payment system diluted the pressure on the hospital for the reform of payment methods;the financial risk of DRG was mainly concentrated in the high-cost disease group;the contribution from the low-cost disease group may lead to the hospital's choice of patients with minor symptoms;“three insurances in one”is conducive for the hospital to parallel the payment.

关 键 词：收付费双轨制 财务管理 DRG 按项目付费 

分 类 号：R197[医药卫生—卫生事业管理]