门诊患者分组对我国医疗保险支付制度的启示  

Enlightenment of ambulatory patient groups on medical insurance payment system in China

作　　者：李学冬 刘玉华[2] 杨振儒[2] 张秀菊[2] 房振环 Li Xuedong;Liu Yuhua;Yang Zhenru;Zhang Xiuju;Fang Zhenhuan(General Office,Zhangjiakou Xuangang Hospital,Zhangjiakou 075000,China;Hebei Medical Information Institute,Shijiazhuang 050021,China;Sino-Singapore Eco-City Hospital of Tianjin Medical University,Tianjin 300567,China)

机构地区：[1]张家口宣钢医院综合办公室,河北省张家口市075000 [2]河北省医学情报研究所,石家庄050021 [3]天津医科大学中新生态城医院,300567

出　　处：《中华医院管理杂志》2020年第6期477-479,共3页Chinese Journal of Hospital Administration

基　　金：河北省卫健委科研基金(20180928)。

摘　　要：现行门诊按项目付费的支付方式诱导需求严重,增加了医保基金的浪费。作者简要介绍了与疾病诊断相关分组理念相同的门诊患者分组(ambulatory patient groups,APG),并结合我国医院门诊医保支付现况及信息化程度提出建议:试点先行,慢性病切入,推进改革;完善门诊电子病历,开发适合我国的APG;老龄化背景下配合总额预算,确保医疗保障力度。The current outpatient payment method based on fee-for-service induced serious demand,which increased the waste of medical insurance fund.The authors briefly introduced ambulatory patient groups(APG)with the same concept of diagnosis-related groups.According to the current situation of outpatient medical insurance payment and the degree of informatization in China,suggestions are put forward:launch a pilot project first and starting with chronic disease to promote reform;improve the quality of outpatient electronic medical records,and develop APG suitable for China;under the background of aging,cooperate with the total budget to ensure the security of medical insurance.

关 键 词：支付标准制定和审核 门诊疾病分组 医疗保险 支付制度 老龄化 

分 类 号：R197.1[医药卫生—卫生事业管理] F842.684[医药卫生—公共卫生与预防医学]