基于疾病特征的医保支付方式优化策略研究——以结核病为例  

Research on Optimization Strategy of Health Insurance Payment Methods based on Disease Characteristics——Taking Tuberculosis as an Example

作　　者：常煜博[1] 贺顺[1] 王侠[2] 唐伟[3] 徐雨虹[1] CHANG Yubo;HE Shun;WANG Xia;TANG Wei;XU Yuhong(Henan Provincial Chest Hospital,Zhengzhou Henan 450000,China;不详)

机构地区：[1]河南省胸科医院,河南郑州450000 [2]河南省财政厅,河南郑州450000 [3]河南省疾病预防控制中心,河南郑州450000

出　　处：《卫生经济研究》2024年第6期31-33,38,共4页

基　　金：河南省科技厅2022年河南省科技发展软科学研究项目“基于大数据的成本管理对优化新冠疫情下结核病医疗卫生资源的研究”(222400410569);河南省卫生健康委2021年度河南省医学科技攻关计划基金资助项目“新医保支付方式下的专科医院成本管控体系构建及应用研究”(RKX202102013)。

摘　　要：目的:探索符合结核病疾病特征的医保支付方式。方法:基于文献研究,分析当前我国结核病的医保支付方式。结果:当前我国结核病支付政策存在制度安排与临床实际不匹配、患者经济负担较重等问题,有必要从疾病特征出发,优化结核病医保支付方式。结论:实行科学动态的结核病门诊单病种支付方式,紧扣疾病特征优化按病种分值付费支付方式,建立全程治疗管理体系,探索捆绑支付模式,减轻结核病患者经济负担。Objective To explore the health insurance payment method that meets the disease characteristics of tuberculosis.Methods Based on the literature study,the current health insurance payment methods for tuberculosis in China were analyzed.Results There were problems such as the mismatch between the institutional arrangement and clinical practice,and the heavy economic burden of patients in the current payment policy for tuberculosis in China.It is necessary to optimize the payment method for tuberculosis from the perspective of disease characteristics.Conclusion It is recommended to implement the scientific and dynamic outpatient single disease payment method for tuberculosis,optimize the payment method according to disease score payment by closely following disease characteristics,establish the whole treatment management system,and explore the bundled payment mode,so as to reduce the economic burden of patients with tuberculosis.

关 键 词：结核病 医保支付方式 疾病特征 优化策略 

分 类 号：R197.1[医药卫生—卫生事业管理]