临床路径管理与病种付费的关系

Opinions on Role of Clinical Pathways Management on Case-Based Payment Reform

按病种付费即固定每个病种服务包的价格,同时规定质量标准,盈亏自负,结余归医院,超支不补。其中,定价和质量控制是两个非常关键的环节。临床路径从过程控制的角度在一定程度上弥补了按病种付费在监管中的盲点,两者相结合可以达到事半功倍的效果。但按病种付费和临床路径管理各有自己的适用范围,超出应用范围后,应采取其他的支付方式和质量监管措施。

The basic principle of the case - based payment is to set a service package for those patients who has a specific principal diagnosis or a major procedure with fixed price while establish certain quality standards, including hospitalization and discharge quality standards as well as related management systems. And hospitals will be responsible for profit and loss, the balance will be owned by hospitals. The pricing and quality control are two critical aspects for case - based payment system. Clinical pathway, from the perspective of process control, to some extent make up for by case - based payment in the regulation of the blind spot, a combination of both can achieve a multiplier effect. However, both case - based payment and clinical pathway man- agement have their own scope and conditions, if it＇s beyond the scope of application, it should take other payment methods and quality control measures instead.