山东省县级公立医院医保支付方式改革实施现状研究

Current Situation Analysis of Reform on Medical Insurance Payment Mode in County-level Public Hospitals in Shandong Province

目的分析县级公立医院医保支付方式改革实施现状,发现问题并提出对策。方法通过邮寄问卷与实地调研的方法收集数据,采用SPSS19.0对数据进行运算处理与分析。结果参与山东省第一、二批县级公立医院改革的医疗机构中160家(92.5%)进行了医保支付方式改革,但支付方式仍较单一;开展按病种限价付费与按病种定额付费的医院中,病种数量超过50种的分别占26.2%、11.4%;63.8%的医疗机构考核结果与医保支付挂钩等。结论应推行复合型付费方式,增加按病种付费的病种数量,克服医保支付方式改革推行过程中来自"医、保、患"三方的阻力,发挥支付方式对医疗机构的正向引导作用。

Objective To analyze the current situation of reform on medical insurance payment mode in coun- ty-level public hospitals, discover problems on payment reform and propose recommendations for county-level pub- lic hospitals. Methods Questionnaires and field research are used to collect data, and soft SPSS19.0 are used to make data analysis. Results Among these county-level public hospitals in Shandong Province participating in the reform of first and second batches, there are 160（92.5%） hospitals carrying out health insurance payment reform, and health insurance payment is in still a single way. 26.2% and 11.4% disease categories are over 50 diseases in disease limited price payment and disease quota payment hospitals. 63.8% medical institutions＇ assessment results are related with medical payment. Conclusion According to the results, it is necessary to promote the method of multiplex payment, and increase the number of diseases payment according to the disease categories. During the process of reforming of medical payment, it is necessary to overcome tripartite resistance coming from ＂medical, insurance, and suffering＂ . This will play a positive role on multiple forms of payment of medical institutions.