按病种(病组)分值结算:现状、做法和评价

Score System with Case Payment under Region Hard Global Budget:Status Quo,Practices and Evaluation

按病种(病组)分值结算是我国地方医保部门依据本地情况创造的中国版疾病诊断相关分组的雏形。这一方式在我国诸多地区得以应用,效果明显,是医保治理结构的重大创新,是重新建立医院、患者和医保之间关系的新运行机制,值得借鉴和参考。本文主要归纳总结我国各地按病种(病组)分值结算的基本情况,介绍基本做法,并进行简单评价。

Score system with case payment under region hard global budget, is the prototype of the Chinese version of diagnosis related groups which created by local government according to its conditions. This method has been applied in Chinese many areas andgot good results. It is a major innovation in the governance structure of medical insurance. It has also established a new mechanism for the relationship of medical insurance, hospitals and patients. This article mainly summarizes the implementation of this system in different parts in our country, introduces the practices, and give a simply evaluation.