徐州按病种付费的实践探索与思考

Practical Exploration of Payment by Disease in Xuzhou

徐州市医保部门坚持问题导向,从制度设计着手,调整医保政策,改革支付机制,逐步形成以总额预算为基础,按病种付费为主,其他付费方式为补充的复合式支付机制。特别是医保的按病种付费,在控制医疗费用不合理上涨、减少基金无效支出、降低基金管理风险、减轻参保人员个人负担等方面作用明显。本文介绍了病种的确定、病种申报的流程以及结算标准的由来;总结了徐州市医保按病种付费所取得的成效,并提出深化医保付费机制改革的思路。

The Healthcare Security Bureau of Xuzhou insists on problem-oriented,starts with system design,readjusts the medical insurance policy,reforms the payment mechanism,and gradually forms a compound payment mechanism based on the total budget.Payment according to disease type plays an important role in controlling the unreasonable rise of medical expenses,reducing invalid fund expenditure,reducing fund management risk,and lightening the personal burden of insured personnel.This paper introduces the determination of disease types,the process of disease declaration and the origin of settlement standards. At the same time,this paper summarizes the achievements of payment according to disease type in Xuzhou,and puts forward some ideas for deepening the reform of medical insurance payment mechanism.