新型农村合作医疗单病种支付的管理方式探析

Management Analysis of the Payment of Single Disease Category on the New Rural Cooperative Medical System

单病种支付作为一种合理控制医疗服务费用的方式,对医疗机构的行为有重要影响。调查发现新农合的单病种的支付方案多采取最高限价和定额补偿相结合的方式,支付标准的设计不尽合理,对医疗质量和过程缺乏监督,遵循临床路径率不高。建议合理确定单病种支付标准,构建新农合单病种支付的管理模式和机制。提高医疗机构与医务人员的积极性,实现控制费用、改善质量和提高管理效率的政策目标。

The payment of single disease category,as a reasonable way of health care costs control,has the major impact on the behavior of medical institutions. The survey finds that the payment of single disease category plan of New Rural Cooperative Medical System usually combines the most price-cap price and fixed compensation method.The design of payment standards is not reasonable,and lacking of supervision on quality of care and medical procedures. The rate of the clinical pathway following is not high. It is suggested that the payment standards of single disease category should be determined reasonably,the single disease management models and the payment mechanisms of the New Rural Cooperative Medical System be constructed to improve the motivation of medical institutions and medical personnel,and to achieve the objectives on cost control,quality and management efficiency.