淮安市按病种分值付费的实证研究

An empirical study of Huaian city, according to the disease score pay

目的:了解淮安市按病种分值付费的实施情况及实施效果,为进一步完善支付方式提供政策参考。方法:采用现场调查表和现场访谈相结合,了解淮安市医保基金运行效率、样本医院整体运行情况及样本医院不同支付方式下单病种的相关情况比较。采用SPSS14.0统计软件建立数据库并进行分析。结果:淮安市医保基金运行效率、样本医院整体运行情况良好,不同支付方式下单病种的相关情况各异。结论:按病种分值付费在费用控制方面已取得显著成效,将医疗质量指标纳入病种分值考核体系中、不断扩容病种目录并加快更新频次、建立互查互审机制是进一步细化、完善制度的有效方法。

Objective：To comprehend the implementation of disease score paid and the implementation effect in Huaian city, provide policy references for the further improvement of payment. Methods：By field survey and interview, compared related to operating efficiency, understood Huaian medical insurance fund and sample hospitals＆#39; overall operation, and compared different sample hospitals single disease payment. The data were collected and analyzed by SPSS14.0 statistical software. Results：The overall operation efficiency,the medical insurance fund sample hospital were good, the related situation of single entity varied under different kinds of payments. Conclusion：The payment which depended on different entities has achieved remarkable results in cost control, we have already taken the medical quality indicators into the disease score evaluation system, and continuously expanded disease directory and accelerated the update frequency. Establishing mutual check a peer review mechanism is an effective method to further refine, improve system.