按病种付费下高值医用耗材医疗服务价格政策现状、影响及建议——以经内镜逆行性胰胆管造影术(ECRP)为例

Analysis of high-value medical supplies price setting policy under the disease fee payment system reform in China:A case of Endoscopic Retrograde Cholangio-Pancreatography(ECRP)

本文结合病种付费制度改革和ERCP技术推广的现状,分析了ERCP价格政策及对患者费用影响,并提出政策建议。ERCP耗材属于"低价"高值医用耗材,但9类疾病患者住院费用中耗材费占比达到35.81%~48.25%,是导致费用昂贵的主要因素之一。由于ERCP耗材未纳入医保支付范围,目前这类患者手术自付比率高、医疗费用昂贵。建议:(1)重视历史结算数据,科学制定病种收费标准;(2)参考治疗方式差异,分类制定病种支付标准;(3)规范手术操作编码,为病种费用测算提供精准数据支持。

This paper analyzes the ERCP price setting policy and its impact on the patient＇s cost and it puts forward possible price setting policy recommendations, according to the current situation of the disease payment sys- tem reform and promotion prospects of ERCP. ERCP belongs to the ＂low-price＂ high-value medical supplies, but hospitalization expenses data of 9 types of diseases show that consumables accounted for 35.81 ~ 48.25%. The main factor hindering widely the application of ERCP lies in high-ratio self-payment and high medical cost, in other words, as the ERCP supplies are not included in the scope of medical insurance payments, the current rate of patients with high surgical expenses, medical costs are expensive. As per the analysis of this paper, the following are the policy recommendations to put forward 1 ）Paying attention to historical settlement data and scientific formulation of disease charges; 2）Considering different treatment methods and allocate appropriate disease payment standards; 3 ）Standard- ize operation code to ensure the information quality of accurate disease exnenses calculati,m