澳大利亚康复医疗服务及医保支付制度的经验与启示  

Experience and Inspiration of Australia’s Rehabilitation Medical Services and Medical Insurance Payment System

作　　者：闫润楠 颜穆丹 肖丹妮 胡琳琳[1] Yan Runnan;Yan Mudan;Xiao Danni(School of Health Policy and Management,Peking Union Medical College,Beijing,100730,China)

机构地区：[1]北京协和医学院卫生健康管理政策学院,北京100730

出　　处：《中国卫生经济》2023年第10期92-96,共5页Chinese Health Economics

基　　金：中国医学科学院医学与健康科技创新工程项目(2021-I2M-1-046);泰康保险集团股份有限公司资助项目(2021P291WJ015)。

摘　　要：完善康复医疗服务体系是满足我国人民日益增长的康复需求的必然要求。构建合理的康复服务定价标准和医保支付制度对促进康复医疗高质量发展具有重要意义。澳大利亚拥有多层次的康复服务体系,建立了以病例组合为基础的康复医保支付制度。对澳大利亚康复医疗服务体系和医保支付体系改革历程进行总结梳理,介绍了澳大利亚国家亚急性和非急性患者分类系统,为我国康复事业发展和医保支付制度改革提供经验借鉴。Improving the rehabilitation medical service system is an inevitable requirement to meet the growing rehabilitation needs of our people.Building a reasonable pricing standard of rehabilitation services and medical insurance payment system is of great significance to promote the high-quality development of rehabilitation.Australia has a multi-level rehabilitation service system and established a rehabilitation medical insurance payment system based on case mix.It summarizes the reform process of the rehabilita⁃tion service system and medical insurance payment system in Australia,and introduces the Australian National Subacute and non-acute Patient Classification,so as to provide references for the reform of medical insurance payment system in China.

关 键 词：康复 医保支付 病例组合 澳大利亚 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] R-01