实行总额控制下按病种分值付费的SWOT分析

SWOT analysis on the payment method of settlement by disease classification under total budget control

医保支付制度是医保管理的核心,科学合理的支付方式,有利于规范医疗行为,促进医疗资源合理配置。控费是当前医保改革的主题,总额控制下按病种分值付费具有控费效果显著、缓解患者就医负担、国家政策支持等优势和机会,同时也存在调整系数不合理等局限性,需进一步完善。因此,本文运用SWOT模型,分析我国各地区实行总额控制下按病种分值付费的现状,总结当前共性问题,继而提出相应的发展策略,为进一步完善按病种分值付费方式提供思路。

The medical insurance payment system is the core of medical insurance management,and the scientific and reasonable payment method is conducive to standardizing medical behavior and promoting the rational allocation of medical resources.The subject of the current medical insurance reform is to regulate the expenses.The payment method of settlement by disease classification under total budget control has the advantages and opportunities for significant effect of regulating the expenses,alleviating the burden of patients'medical treatment and national policy support.There are also limitations such as unreasonable adjustment factors,which require further perfect.Therefore,this paper uses SWOT model to analyze the implementation status of payment method of settlement by disease classification under total budget control in various regions of China,summarizes the current common problems,and then proposes corresponding development strategies to provide ideas for further improvement.