某省三种基本医疗保险支付方式调查与思考

Investigation and thinking on three kinds of basic medical insurance payment methods in one province

采用普查的方式收集各级医疗机构出院病人数据资料,了解三种医保制度支付方式在各级医疗机构中的应用情况;筛选出能够在县级医疗机构中诊治的病种,计算这些病种在省、市、县级医疗机构的出院费用、医保报销费用和自负费用等。结果显示:支付方式改革逐渐从原来的按项目付费过渡到按病种付费、按人头付费、按总额付费和按床日付费,但许多能够在县级医疗机构诊治的疾病流向了更高一级的医疗机构,患者的自负费用大幅增加。因此,需要进一步改革支付方式,提高医保基金使用效率。

By collecting the data of discharged patients in different levels medical institutions using Census method, this paper aimed to understand the application status of three kinds of medical insarance system payment at all kinds of levels medical institutions, screen out the diseases that can be diagnosed and treated in the county-level medical institutions and calculate the discharge expenses, reimbursement expenses and out-of-pocket expenses of these diseases in the medical institutions at the provincial, city and county levels. The results showed that the reform of the payment method gradually shifted from the item-based payment to the disease-based payment, the per capita payment, the total payment and the bed-day payment, but many diseases that could be diagnosed at the county-level medical institutions went to a higher level medical institutions, thus, the out-of-pocket expenses for patients increase substantially. Therefore, our government needs to further change the payment method to improve the efficiency of health insurance funds.