医疗服务提供方对按病种定额付费政策的认知现状——以四川省成都市为例

Study on the cognition status of implementing case-based payment policy among healthcare providers: A case in Chengdu,Sichuan Province

目的:了解医疗服务提供方对按病种定额付费政策的认知现状,为进一步完善相关政策提供依据。方法:采用半结构式访谈方法,对9家医院38名工作人员和患者进行深入访谈。结果:各级医院积极执行按病种定额付费政策,并制定了相应的费用控制和管理措施,但各医院按病种定额结算的病例比例较低,在执行过程中存在着对病例纳入依据认识不一致、医疗服务提供方认为费用标准制定较为笼统等问题。结论:成都市按病种定额付费取得了一定成效,但也存在一些问题,需根据病种费用信息测算标准费用,完善按病种定额付费结算方式;进一步明确按病种定额付费病例的纳入依据和原则;逐步增加按病种定额付费疾病的种类;加强对医疗服务提供方的监管力度;引导医疗服务提供方建立有效的激励机制。

Objective ： To understand the implementation status of case-based payment among healthcare provid- ers and their cognition on the matter. Methods ： Semi-structured interview was conducted on 30 purposely selected staff from 9 hospitals in Chengdu. Results：After one-year implementation of case-based payment, hospitals at different level carried out the policy vigorously： executed corresponding expense control measures and management. Neverthe- less, the proportion of cases that were paid with case-based payment was low, moreover the inclusion criteria for case was of disunity and the formulation of the expense standard was ambiguous to some extent. Conclusion： Certain achievements were accompanied with problems, so it is essential to refine reimbursement standards, improve case- based payment, make clear the inclusion criteria for case and extend the covering range of case-based payment in Chengdu. In addition, the medical insurance agency should strengthen the supervision of healthcare providers, and guide them to set up effective incentive mechanism.