医疗服务预付费体系研究概述

Summary of study on medical service prepayment system

目的推荐北京市有条件采用的相对最佳的医疗服务预付费支付方式，为建立适合北京市情况的医疗费用支付体系提供科学依据。方法剖析北京市医疗费用支付方式的现状及存在的问题；对439名利益相关者进行问卷调查，了解其对现行支付方式的看法及进行支付方式改革的需求；深入研究国内13个城市及国外部分国家医疗费用支付方式的现状及改革经验，并根据课题组制定的6项评价指标，对19位专家开展问卷调查，最终对各种支付方式进行了整体优劣排序。结果北京市目前的医疗费用支付方式存在各种问题，需要进行制度性调整；各利益相关者对支付方式改革的必要性和迫切性已基本达成共识，北京市存在支付方式改革的社会需求；各种支付方式均有其优缺点，专家咨询结果显示得分最高的是按DRGs付费方式。结论北京市进行支付方式改革具有迫切性和必要性；北京市对住院病人应实行以DRGs-PPS为主的支付方式；需开展以费用为基础的DRGs-PPS支付方式逐步转换为以成本为基础的DRGs—PPS支付方式的后续研究。

Objective To recommend the relatively best medical service prepayment mode available in Belling and to provide scientific basis for establishing a suitable medical service payment system. Methods The present situation and problems in payment mode of medical expenses in Beijing were analyzed. A questionnaire survey was conducted in 439 interest-related persons to understand their views on the current payment mode and their demands on reform. In-depth study of the status and the reform experience of medical expenses payment mode in 13 domestic cities and some foreign countries was conducted, and 19 experts were surveyed through questionnaire containing 6 evaluation indexes formulated by our study group to generate a final ordering according to the superiority or inferiority of various payment modes. Results There are various problems existed in Beijing＇s current ＇medical expenses payment mode, and the system is required to be adjusted. All interest-related parties have basically reached a consensus on the necessity and urgency of the payment mode reform. Various payment modes all have their advantages and disadvantages, among which diagnosis related groups-prospective payment system （DRGs-PPS） earned the highest score given by experts. Conclusion Reform of medical expenses payment mode in Beijing has its urgency and necessity. DRGs-PPS should be implemented to inpatiertts, and the subsequent research should be conducted to gradually convert the expense-based DRGs-PPS to cost-based DRGs-PPS.