具有中医特色的按病种付费初探

A Preliminary Study on Payment by Disease Type With TCM Characteristics

积极推进按病种收付费可以有效控制医疗费用的不合理增长,有效规范医疗服务行为,有利于分级诊疗工作的开展,可以积极引导参保人员的控费意识。在徐州市现有的675种单病种结算标准中,仅有9种为中医结算方式。通过分析按病种付费结算的激励政策以及分析临床开展按病种结算方式的瓶颈,突出中医特色,寻找中医优势病种,积极申报开展中医单病种,中西医并重,加强管理,规范临床路径,逐步探索出具有中医特色的按病种结算方式。既提高医保患者补偿比例,又弥补了医保中心因统筹基金定额不足造成医院的经济损失。

Actively promoting payment by disease type can effectively control the unreasonable increase of medical expenses, effectively standardize the medical service behavior, which is conducive to thedevelopment of hierarchical diagnosis and treatment work, and can actively guide the insurance participants’ awareness of cost control. Of the current 675 single disease settlement standards in Xuzhou, only 9 are TCM settlement methods. Through the analysis of the incentive policy of press disease to pay settlement and analyze clinical conduct press disease to plant the bottleneck of the method of payment, highlight the characteristics of traditional Chinese medicine and find advantages of traditional Chinese medicine disease, actively declare for single disease of traditional Chinese medicine, traditional Chinese and western pay equal attention to, strengthen management, standardize the clinical pathway, gradually explored press disease with TCM characteristics and settlement way. It not only increases the proportion of medical insurance patients’ compensation, but also makes up for the economic loss of hospitals caused by the insufficient fund quota of the medical insurance center.