门诊慢病包干付费的探索——以柳州市城镇职工医保慢病管理为例

A New Mode of Pay per Disease for Out-patient Chronic Diseases Based on Practice in Liuzhou

针对慢病患者不断增加、医疗费用过快增长的问题,柳州市创新医保支付机制,主要做法和政策措施是:制定门诊慢病费用标准,实现一个病种一个标准;对不同等级的定点医疗机构实行差别较大的支付比例和统筹基金支付标准,并实行"超支不补、结余留用"的门诊慢病费用包干付费机制。这些改革措施实施后,增强了医疗服务供方的"提质控费"意识,统筹基金支出明显下降,三级医院收入与一级及以下医疗机构收入之比由改革前的3:1变为1:3以上,助推分级诊疗效果明显。完善门诊慢病费用包干付费机制,尚需建立慢病费用标准的动态调整机制,不断增强对医疗供方主动控费的激励约束。

According to the number of people with chronic diseases and the medical cost increasing rapidly, Liuzhou created a new medical insurance payment mechanism. The main measures are as followed： the expense standard of each out-patient chronic disease is developed; the proportion of pooling fund will be obvious different, if medical cost is over pended will be not compensate and the balance will be kept using. After taking these measures, the awareness of providers of medical care which improves service quality and control medical cost is raised. The medical insurance pooling fund expenditure is decreased. A 3：1 split is turned into 1：3 split of medical income between the top class and the first class hospitals. The classified medical treatment is boosted remarkably. To improve this mechanism, we should set up a dynamic adjustment mechanism and enhance the motivation and restriction mechanism to control medical spend by medical care providers actively.