总额控制下按病种分值付费的实践与思考

Practice and Thinking of Scoring Diseases Payment under the Control of Total Budget

目的:了解我国部分地区总额控制下按病种分值付费的实施情况,为进一步完善付费方式提供参考。方法:以总额控制下按病种分值付费的操作流程为基础,比较我国台湾地区、淮安市、南昌市、中山市4个地区对其的具体实践。结果:按病种分值付费在总额的控制与分配、病种分值的建立、调整系数的设定、结算方法的制订、配套机制与监督考核方式的设置等方面存在差异。结论:总额控制下按病种分值付费是否应按诊疗方式进行病种细分、如何合理设定调整系数、如何进行病种分段补偿以及如何强化监督管理等问题仍需进一步思考和探索。

OBJECTIVE：To study the implementation of scoring diseases payment under the control of total budget in some areas of China,and provide reference for the further improvement of the payment. METHODS：Based on the operation process of scoring disease payment in the control of toal budget,the specific practices of Huaian,Nanchang,Zhongshan and Taiwan Region,were compared. RESULTS：It showed differences in the control and allocation of total budget,the establishment of scoring diseases,the setup of adjustment coefficient,the development of balance methods,the complementary mechanism and the monitor examination setting. CONCLUSIONS：Whether to classify the diseases according to diagnosis and treatment methods,how to setup adjustment coefficient appropriately,how to reimburse the patients in stages and how to strengthen supervision are worthy of further thinking and exploring.