终末期肾病门诊透析治疗医疗保险定额支付的横断面研究

Quota Payment of Dialysis Treatment of Outpatients in Chengdu: A Cross Sectional Study

目的探索成都地区终末期肾病门诊透析治疗的定额支付评价指标及其合理额度,为单病种付费提供科学依据。方法采用问卷调查法收集患者的费用信息,根据治疗原则及统计结果制定赋值评价指标;采用德菲尔法确定赋值分值及定额支付标准。结果本调查涉及17家成都市医疗保险特约透析机构,共发出调查表700份,收回调查表686份,排除项目填写漏项、患者治疗信息不准确的调查表26份后,实际纳入分析的调查表共660份,占调查总人数的94.28%。调查结果显示:血液透析治疗率占调查人群的84%(555/660),腹膜透析治疗率占调查人群的16%(105/660)。通过评估项目赋值后获得的血液透析门诊最低年支付额118 242.75元,腹膜透析门诊最低年支付额96 498.00元。结论通过治疗项目赋值后的门诊透析定额支付证据性强,门诊透析治疗的分级定额支付可使医疗保险基金得到更合理的应用。

Objective To explore the medical insurance quota payment of dialysis treatment for outpatients with end-stage renal disease in Chengdu from following aspects, evaluation indexes and reasonable amount, so as to provide scientific basis for the payment of single disease. Methods A questionnaire survey was conducted to collect the cost information of patients, and to formulate the assignment of evaluation indexes according to the therapeutic principles and statistical results; Delphi method was adopted to determine the assignment and the standard of quota payment. Re- sults A total of 17 dialysis organizations approved by Chengdu municipal medical insurance were involved in this study. Of 700 questionnaires distributed, 686 were retrieved. After excluding 26 questionnaires for incomplete filling and incorrect treatment information, a total of 660 questionnaires were included actually, accounted for 94.28% of all informants. The results of survey showed that, the hemodialysis treatment rate accounted for 84% （555/660） of all infc）rmants, while the peritoneal dialysis treatment rate accounted for 16% （105/660）. By assessing the project assignment of outpatient dial- ysis treatment, the minimum annual payment of hemodialysis was RMB 118 242.75 ）,uan, while that of peritoneal dialysis was RMB 96 498.00 yuan. Conclusion The quota payment of outpatient dialysis shows strong evidence atier adopting the treatment project assignment. The grading quota payment of outpatient dialysis enables the medical insurance fund to be more reasonably used.