山东省新农合单病种支付方式的实施效果分析

单病种支付作为一种合理控制医疗服务费用的方式,对医疗机构的行为有重要影响。调查显示,支付方案多采取最高限价和定额补偿相结合的方式,基层医院、民营医院执行的主动性相对较高,财务收入增高,诊疗质量也有改善。参合人员实际受益有限,遵循临床路径率不高,支付标准的设计不尽合理,大医院执行的动力不足。建议合理确定单病种支付标准,以乡镇卫生院、专科医院为实施重点,逐步推进到三级综合医院;建立质量与费用监控的指标体系、科学的考核和评价机制。

Analysis of Implementation Effect of Single Disease Payment Method of New Rural Cooperative Medical System in Shandong Province

Single disease payment method, as a legitimate way to control health care costs, has important influence on the behavior of medical institutions. Payment method usually take the method of the combination of ceiling price and fixed compensation. The initiative of primary hospitals and private hospitals is relatively high. Financial income increases, and the quality of care also improves. Participating officers actually have limited benefits, the rate of following the Clinical Pathway is not high, design of payment criteria is not reasonable, and executive power of large hospitals is insufficient. It is suggested to rationally determine the single disease payment standard, impel to the comprehensive tertiary hospitals through focusing on the implementation of the township hospitals and specialty hospitals, and establish quality and cost monitoring index system and scientific assessment and evaluation mechanisms to achieve the policy objectives of control of costs, and the improvement of medical quality and management efficiency.