美国康复医保支付方式的发展与启示  

The Development and Enlightenment of Rehabilitation Medical Insurance Payment Methods in the US.

作　　者：李曼[1] LI Man(China Rehabilitation Research Center,Beijing,100068,China)

机构地区：[1]中国康复研究中心,北京100068

出　　处：《中国卫生经济》2021年第11期89-92,共4页Chinese Health Economics

基　　金：中国康复研究中心青年基金项目(2021zx-Q13)。

摘　　要：目的:探索能够解决日益增长的康复需求和控制康复医疗费用两大难题的康复医保支付方式。方法:通过回顾美国康复医保支付方式的发展史,总结多种支付方式的优缺点以及对康复医疗的适用性。结果:相同的患者采用3种康复医保支付方式进行分组,按诊断相关分组方式最笼统,以患者为中心的支付分组方式最能体现不同康复患者的疾病特点和资源需求。结论:按诊断相关分组支付对恢复期康复医疗不适用,我国应加快建设完善的三级康复医疗体系,建立统一的康复医疗数据库,制订适合中国人的功能评价量表,构建适合我国国情、关注功能的康复医保支付体系。Objective:To explore the payment method of rehabilitation medical insurance,which can solve the growing rehabilitation demand and control the rehabilitation medical expenses.Methods:By reviewing the development history of American rehabilitation medical insurance payment methods,the advantages and disadvantages of various payment methods and their applicability to rehabilitation medical treatment were summarized.Results:The same patients were grouped by three payment methods of rehabilitation medical insurance,among which DRG was the most general and Patient Driven Payment Model(PDPM)could best reflect the disease characteristics and resource needs of different rehabilitation patients.Conclusion:DRG payment is not suitable for convalescent rehabilitation.It is needed to speed up the construction of a sound three-level rehabilitation medical system,establish a unified rehabilitation medical database,formulate a functional evaluation scale suitable for Chinese people,and construct a rehabilitation medical insurance payment system suitable for China’s national conditions and paying attention to functions.

关 键 词：康复服务 医保支付方式 美国 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] F840.62[经济管理—保险]