基于理论分析与地区经验的住院总额预算与按病种付费协同衔接研究  

Research on the Collaboration and Combination of Global Budget and Case-based Payment Based on Theoretical Analysis and Regional Experience

作　　者：孙晨晗 钱旦青 王馨慧 胡敏[1] 陈文[1] Sun Chenhan;Qian Danqing;Wang Xinhui(School of Public Health,Fudan University,Shanghai,200232,China)

机构地区：[1]复旦大学公共卫生学院,上海200232

出　　处：《中国卫生经济》2024年第7期32-35,51,共5页Chinese Health Economics

基　　金：国家社科基金重大项目(20ZDA072)。

摘　　要：国家要求将医保总额预算与按病种付费相结合,因此,如何有效衔接两者成为推行支付改革的重点与难点。研究在理论分析基础上,分别选取实行区域总额下按病种付费和实行机构总额下按病种付费的地区,分析总额预算与按病种付费的协同衔接机制,包括区域层面总额预算的严格总控、机构层面预算或预期服务量标准的合理设定、超量服务结算的费率浮动与打折机制;进一步梳理各地区在总额预算与按病种付费背景下对于支持创新和提升质量方面的额外激励机制。医保改革可借鉴典型地区经验,加强区域预算、机构预算与按病种付费之间的协同衔接,谨慎应对区域点数法可能产生的过度竞争与“冲点”风险。China’s healthcare payment reform seeks to combine a medical insurance point-system with a global budget.The focus and difficulty in implementing the payment reform is how to make effectively link.On the basis of theoretical analysis,it selects the regions that have implemented the payment by disease under regional total budget and the payment by disease under institutional total budget,and summarizes the synergistic mechanism of total budget and payment by disease,including the strict control of total budget at the regional level,the reasonable setup of the budget or the standard of expected service volume at the institutional level,and the rate fluctuation and discount mechanism for the settlement of excess service;and further sort out the additional incentive mechanism to support innovation and quality enhancement under the background of the total budget and the payment by disease.Lessons can be drawn from the experiences of typical regions to strengthen the synergy between regional budgets,institutional budgets and payment by type of disease,and cautiously deal with the risks of excessive competition and“punching points”that may arise from the regional point method.

关 键 词：总额预算 按病种付费 协同 地区经验 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] F019.6[经济管理—政治经济学]