新型农村合作医疗制度下单病种付费方式的实施状况研究

Research on the Implementation of Single -DRGs Reform under Chinese New Rural Cooperative Medical System

目的:研究新型农村合作医疗制度下单病种付费方式的实施状况。方法:运用医疗保险理论分析新型农村合作医疗制度下单病种付费方式对县域内参合患者住院人次及医疗费用流向的影响。结果:各县均存在较大程度的患者外流现象,单病种支付制度对县域内住院人次的覆盖面较小,对费用控制的约束力也十分有限。结论:建议加快县域内医疗机构的服务能力建设以减少外流患者比重,加强新型农村合作医疗经办机构对医疗机构服务行为的监管,同时积极探索其他可以实现"两个全覆盖"的支付方式改革。

Objective： To study the implementation of single-type of DRGs reform in new rural cooperative medical system （NCMS）. Methods： On the basis of health insurance theory, to analyze the influenced flow of inpatient visits and medical expenses led by the single-type of DRGs under the NCMs. Results： There are greater degree of patients＇ outflows in counties. Single disease payment system covers smaller parts in township inpatients. Conclusion： To suggest on strengthening the medical service capacity of medical institutions in order to reduce the inpatients outflows, and strictly supervise medical service of medical institutions. Meanwhile other payment systems reform that can cover all the institutions and diseases should be explored.