上海市按病种分值床日付费改革的整体构思与制度设计  

Overall Conception and Policy Design of the Reform of Per-Diem Payment based on Diagnosis-Intervention Packet in Shanghai

作　　者：徐嘉婕 吕大伟 朱碧帆 李芬 金春林[1] XU Jiajie;LYU Dawei;ZHU Bifan;LI Fen;JIN Chunlin(Shanghai Health Development Research Center(Shanghai Medical Information Center),Shanghai 200040,China;不详)

机构地区：[1]上海市卫生和健康发展研究中心(上海市医学科学技术情报研究所),上海200040 [2]上海市医疗保障局,上海200125 [3]复旦大学公共卫生学院,上海200032 [4]上海市卫生健康委员会财务管理事务中心,上海200040

出　　处：《卫生经济研究》2024年第6期23-26,共4页

基　　金：拜耳医药保健有限公司“上海市按病种床日付费研究”(2022036B)。

摘　　要：综合考虑本地支付改革整体构架,以及医疗机构管理的稳定性、一致性和延续性,上海市积极探索对长期住院开展按病种分值床日付费。通过对2020—2022年住院病案数据进行模拟测算,结果显示,整体的模拟补偿率较平稳,但还需进一步完善按病种分值床日付费的支付标准及支付方式,设置更加符合实际的结算周期,并加强监管与评价。Considering the overall framework of local payment reform,as well as the stability,consistency and continuity of medical institution management,Shanghai has actively explored per-diem payment based on diagnosis-intervention packet for long-term hospitalization.The simulation results showed that the overall simulated compensation rate was relatively stable based on data of inpatient medical records from 2020 to 2022.It is suggested to further improve the payment standards and payment system for per-diem payment based on diagnosis-intervention packet,set a more realistic settlement cycle,and strengthen supervision and evaluation.

关 键 词：按床日付费 支付方式改革 按病种分值 上海市 

分 类 号：R197.1[医药卫生—卫生事业管理]