肺结核病患者全疗程捆绑式整合支付设计与成效分析  

Analysis on the Design and Effectiveness of Bundled Payment for the Full Treatment Course of Tuberculosis Patients

作　　者：应亚珍 徐德斌 陈家应[2] 王萱萱[2] 桓世彤 汪宏 

机构地区：[1]首都医科大学国家医疗保障研究院,北京100037 [2]南京医科大学,南京211166 [3]比尔及梅琳达·盖茨基金会,北京100000

出　　处：《中国医疗保险》2024年第12期17-22,共6页China Health Insurance

基　　金：首都医科大学国家医疗保障研究院-比尔及梅琳达·盖茨基金会结核病防治合作项目(INV-004900)。

摘　　要：2022年,保定市将捆绑整合支付政策设计应用到肺结核病患者全疗程的门诊与住院整合医保支付方式改革中。经过一年实施运行,同步加强疾病诊治能力建设、提高医疗质量考核管理、优化诊疗方案等一系列举措,激发了医疗服务供方的内生动力,取得了一定的成效。本文主要对实施改革前后全市结核病全疗程诊疗数据进行统计和对比分析,发现按门诊与住院捆绑整合支付降低了患者重复住院比例,提高了门诊服务利用和菌阳患者的发现率,实现了医疗服务有效利用和医疗资源合理消耗,相应的医疗费用下降。In 2022,Baoding City implemented a bundled payment policy,integrating outpatient and inpatient expenses for the full treatment course of tuberculosis patients into the medical insurance payment reform.Over the course of a year,this reform was accompanied by initiatives to enhance disease diagnosis and treatment capabilities,optimize medical quality assessment and management,and improve treatment plans,effectively stimulating the intrinsic motivation of healthcare providers and achieving notable outcomes.This study conducts a statistical and comparative analysis of tuberculosis treatment data before and after the reform in Baoding City.The results indicate that the bundled payment approach integrating outpatient and inpatient expenses significantly reduced the proportion of repeated hospitalizations,increased the utilization of outpatient services,and improved the detection rate of bacteriological positive patients.It facilitated the efficient utilization of healthcare services and the rational consumption of medical resources,while reducing healthcare costs.

关 键 词：捆绑支付 总额预算 支付方式改革 肺结核 全程医疗服务 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]