南昌市总额控制下按病组分值付费医保支付方式改革实践  

Reform practice of medical insurance payment method based on disease group value payment under the total amount control of Nanchang

作　　者：廖唐洪[1] 雷良华[1] 胡昢宏 王苏婷 张文燕 陈萍 LIAO Tanghong;LEI Lianghua;HU Peihong;WANG Suting;ZHANG Wenyan;CHEN Ping(Jiangxi Provincial People's Hospital,The First Affiliated Hospital of Nanchang University,Nanchang,Jiangxi Province,330006,PRC)

机构地区：[1]江西省人民医院(南昌医学院第一附属医院),江西省南昌市330006

出　　处：《中国医院》2023年第7期84-86,共3页Chinese Hospitals

基　　金：江西省自然科学基金项目(2018BAA208035);江西省卫生健康委科技计划(20175054)。

摘　　要：医保支付方式改革是深化医改的重要环节。南昌市于2020年开始实行总额控制下按病组分值付费的医保支付方式改革,取得良好成效。医保统筹基金支出运行平稳,定点医疗机构医保资金略有盈余,对定点医疗机构约束效果明显,人均住院费用和平均住院天数均不同程度下降,引导医疗机构主动合理控费。后续需要精细化设置质量系数考核指标,制定激励措施鼓励医疗新技术新项目的开展。Medical insurance payment method is an important part of promoting medical reform.Nanchang began to implement the reform of medical insurance payment by disease group score under total budget control in 2020,and it achieved good results.Expenditure of the medical insurance pooling fund was stable,and the designated medical institutions had a slight surplus of medical insurance funds,the effect of restraint on designated medical institutions was obvious,Both the per capita hospitalization costs and the average number of days in hospital declined,and the medical institutions were encouraged to control expenses initiative and reasonably.It is necessary to set the quality coefficient assessment index in more elaborate and formulate Incentive measures to encourage the development of new medical technologies and projects.

关 键 词：医保支付 医疗保险 支付方式 按病组分值付费 总额控制 

分 类 号：R197.3[医药卫生—卫生事业管理]