河南某县病种临床路径分组及政府购买服务的实践

Clinical pathways grouping for diseases and government service procurement in a county in Henan

为有效解决当前单病种临床路径管理纳入率低、退出率高的问题，在传统临床路径管理的基础上，根据DRGs分组管理的思想，结合我国实际，提出了按病种分组管理的理念，通过引入质量控制机制、价格谈判机制、绩效支付机制和监督管理机制等政府购买服务的措施，旨在实现调动医疗机构和医务人员积极性，控制医疗费用不合理增长，优化费用结构，提高医疗服务质量和患者满意度等目标。河南省借助中国农村卫生发展项目，试行按病种临床路径分组管理理念和政府购买服务方式后，病种覆盖范围和覆盖人群明显扩大，患者次均费用水平得到了有效控制，体现医护人员劳务价值的手术和治疗费用不断提升，药品占比由改革前的约50％，下降到了30％以下的平均水平，医疗费用构成比逐渐优化，医疗质量也明显改善，使得医、保、患三方都满意。

For the purpose of resolving such current problems as low inclusion ratio and high exit ratio in the single-disease clinical pathway management, the paper proposed an idea of clinical pathways grouping management, in line with DRG management and based on traditional clinical pathway management practice and China＇ s conditions. Proposed in the paper are such measures for government service procurement, as quality control mechanism, price negotiation mechanism, performance-based payment mechanism,and supervision mechanism. These measures are designed to provide incentives for medical institutions and medical workers, control irrational rise of medical expense, optimize expense makeup,and improve both quality of care and patient satisfaction. Thanks to the China Rural Health Development Project in place in Henan province where DRG-based clinical pathway grouping management and government service procurement are in trials, the following outcomes are achieved. Namely, significant expansion of diseases coverage and population coverage, efficient control of per-patient/per-visit expenses,and a steady rise of surgery and treatment expenses which embody value of service of medical workers. Other benefits include 50% to less than 30% drop of drugs proportion, gradual optimization of medical expenses makeup, obvious improvement of quality of care. These measures have made hospitals, insurance providers and patients satisfactory.