南通市住院费用总额预付制下不同结算方法实施效果评价

Evaluation of Payment Reform on Different Hospital Expenditures Reimbursement under Global Budget in Nantong

目的:评价南通市总额预付制下的结算办法的运行效果。方法:从供需双方的视角,分析不同结算方式对年人均住院次数、次均住院费用、次均医保支付及个人自付比,并建立回归模型评价运行效果。结果:患者年住院两次以上人数逐年增加,三级医院的住院费用年均增长高于二级医院,多因素回归结果发现:增幅管理模式2有效地促进医疗机构降低次均住院费用及次均医保支付费用,尤其是二级医院;次均个人自付支付比例下降了2.48个百分点。结论:医保管理部门应建立总额预付下的价格谈判机制,探索综合支付方式改革。

Objective： To evaluate the operation effect of the payments under total budget system in Nantong. Methods： From the perspective of both the supply-sides and the demand-sides, it analyzed the ratio of different payments on yearly per capita hospitalization times, inpatients＇ medical costs, the costs paid by medical insurance and out-of-pocket （OOP）costs, and then established the regression model to evaluate the operation effect. Results： The patients hospitalized more than 2 times increased by years, inpatients costs of tertiary hospitals grew higher than the secondary hospitals, the regression results found that the growth management model two helps to decrease average inpatient expenditure and reimbursement inpatients admission, especially for secondary hospitals; the ratio of average OOP expenditures dropped by 2.48%. Conclusion： The health care management administration should establish negotiation mechanism under the global budget payment, and explore the integrated payment reform.