上海市部分诊疗项目按绩效支付改革试点方案设计研究  

Project design study on the pilot reform of paying for performance method for some medical procedures in Shanghai

作　　者：刘柳 陈天池 张钰 夏宇 杨毅 陈英耀[1] Liu Liu;Chen Tianchi;Zhang Yu;Xia Yu;Yang Yi;Chen Yingyao(School of Public Health,Fudan University/NHC Key Laboratory of Health Technology Assessment,Shanghai 200032,China;Shanghai Healthcare Security Administration,Shanghai 200125,China;Shanghai Fengxian District Medical Insurance Affairs Center,Shanghai 201400,China)

机构地区：[1]复旦大学公共卫生学院/国家卫生健康委员会卫生技术评估重点实验室,上海200032 [2]上海市医疗保障局,上海200125 [3]上海市奉贤区医疗保险事务中心,上海201400

出　　处：《中华医院管理杂志》2022年第6期439-442,共4页Chinese Journal of Hospital Administration

摘　　要：按绩效支付作为创新支付方式的主要类型之一,将支付和医疗服务质量相结合,以提高医疗卫生服务的效率和患者满意度。为加速医疗新技术的临床引用,提高患者对创新技术的可及性,降低患者疾病经济负担,上海自2021年4月开始,对7种微小核糖核酸检测、人工智能辅助治疗技术、肿瘤消融治疗技术(冷冻)3项新技术诊疗项目推行按绩效支付方式改革试点。通过多轮的专家咨询和实地调研,最终确定阳性检测率、并发症发生率和肿块缩小情况分别作为3项技术的医保支付绩效考核指标,并明确相应的考核支付标准。上海按绩效支付改革试点可为各地开展按绩效支付提供参考。With the continuous advancement of the deepening reform of the medical security system,the medical insurance payment method,as an important part of it,has become the focus of the reform.As one of the main types of innovative payment methods,payment for performance combines payment and medical service quality to improve the efficiency of medical and health services and patient satisfaction.In order to accelerate the clinical application of new medical technologies,improve patients′access to innovative technologies,and reduce the disease economic burden of patients,Shanghai has carried out a pilot reform of paying for performance for three new technologies including Cryoablation in the treatment of cancer,Da Vinic Robotic Surgical System and Plasma MicroRNA Panel detection.Through multiple rounds of expert consultation and on-the-spot investigation,the positive detection rate,complication rate and tumor reduction rate were finally determined as the performance evaluation indicators of the three technologies,and the corresponding payment standards were defined.The pilot reform in Shanghai could provide reference for other regions to carry out performance based payment.

关 键 词：卫生保健改革 医保支付方式 创新技术 绩效支付 考核指标 

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]