我国医疗服务按病种收付费试点工作现状分析

Analysis of Current Situation of Paying by Disease Types Pilot Project in China

目的:了解我国医疗服务按病种收付费试点工作的实施现状,为进一步推行相关政策提供参考。方法:采用文献研究(除港、澳、台及西藏以外的30个省(区、市))、问卷调研(9个典型地区)、实地考察(2家示范医院)和典型案例分析的方法,对我国医疗服务按病种收付费试点工作现状进行研究,并提出建议。结果与结论:截至2010年9月,我国大陆各省(区、市)普遍开展了不同形式的按病种收付费试点工作。病种基本遴选原则为:常见病、多发病;发病原因明确、发病机制清楚;没有其他并发症的单纯性疾病等。但大多数调研地区还没有形成统一、规范的病种临床路径。按病种收付费降低了试点病种费用,增加了试点机构的业务量,改善了医患关系,但也普遍存在缺乏法律与政策支持、相关部门配合不力、试点范围有限等问题。建议进一步完善相关法律与政策,建立部门协调配合机制,明确试点范围,加强质量监督系统建设,以确保相关政策不断完善及顺利推行。

OBJECTIVE： To investigate the current situation of Paying by disease types pilot project in China, and to provide reference for the further implementation of related policies. METHODS： By literature review （30 provinces, municipalities and au- tonomous regions except Hong Kong, Macao, Taiwan and Tibet）, questionnaire survey （9 typical regions）, on-site inspection （2 demonstration hospitals） and case study, the current situation of Paying by disease types pilot project in China was analyzed to put forward suggestions. RESULTS ＆ CONCLUSIONS： Up to Sept. 2010, all provinces but Tibet in mainland of China had put the payment reform into practice. The principle of disease type＇ s selection is as follows： common disease, frequently-occurring dis- ease; definite cause of disease, clear nosogenesis; simple disease without other complication, etc. There isn＇t uniform and standard disease clinical pathway in most surveyed districts. Paying by disease types decrease the cost of pilot disease types but increase vol- ume of business and improve the doctor-patient relationship. However, there exist law and policy support deficiency, poor coopera- tion of related department, pilot scope limit and other problems. It is suggested to further improve related law and policies, estab- lish cooperation and coordination mechanism of departments, define pilot scope and strengthen quality supervision system to guaran- tee the improvement and smooth implementation of related policies.