基于单病种付费的新型农村合作医疗支付方式改革研究——以安徽省南陵县为例

Research on the Reform of New Rural Cooperative Medical Payment System Based on Single Disease——Take Nanling County of Anhui Province as an Example

目的:在分析参合患者住院次均费用涨幅明显的基础上,依托单病种支付方式探讨病种的科学选取及其费用拟定,以达到控制医疗费用的目的,从而确保参合患者利益最大化。方法:采用Excel统计软件对安徽省南陵县2011-2013年参合人员住院数据进行处理分析。结果:通过获取该地参合住院数据统计共有139种病种纳入该县的试行病种范围,其中有112个病种的费用呈现出不同程度的上涨趋势,占据总病种的80.58%,单病种的费用波动明显。对策建议:及时调整医疗机构补偿方案应对医疗费用快速增长的影响;积极推行混合支付方式改革,实现对住院病种的全面覆盖;建立质量控制指标、建立健全医疗机构的分级转诊制度。

Objective：Based on the analysis of the participation of patients hospitalization expenditure rose significantly, this article fo-cused relying on single disease payment to explore scientific disease selection cost and proposed to control health costs, to ensure the participation of patients benefit maximization. Methods： the hospital：zation data of personnel participation of 2011-2013 in Nanling county of Anhui province were analyzed using Excel statistical software. Results： by acquiring the participation of hospital statistics a total of 139 kinds of diseases in the county＇s trial disease range, of which 112 disease costs showing a rising trend in different degree, occupy the total disease 80. 58% of the number, single disease costs flucturate obviously. Countermeasures and suggestions：timely ad-just the financing and compensation plan and other measures to cope with the rapid growth of medical expenses, and actively promote the reform of mixed payment, to achieve a comprehensive coverage of the disease, the establishment of quality control indicators, estab-lish a sound system of medical institutions.