乐山市某三甲医院老年性白内障手术患者按病种付费实施效果分析

Analysis of Implementation Effect of Case-based Payment of Patients Undergoing Senile Cataract Surgery in a Grade-A Tertiary Hospital in Leshan City

目的:分析老年性白内障手术患者按病种付费实施效果,为医保支付改革提供参考。方法:以乐山市某三甲医院老年性白内障手术患者为研究对象,将按病种付费的患者257例作为政策组,同期未实施按病种付费的患者331例作为对照组,对比两组平均住院费用、平均住院日、费用结构等,分析政策执行情况及实施效果。结果:政策实施后,政策组平均医保支出、平均自付费用均低于对照组(P<0.05)。医保支付、患者自付费用减少,但超支病例平均超出医保定额标准的10.37%,费用标准缺乏适时调整机制导致医院层面政策推行力度不够,医务人员积极性不高。结论:按病种付费政策的实施取得了积极成效,但仍应建立病种费用标准的适时调整机制,进一步加大政策约束与引导,建立健全科学合理的绩效考核及激励机制。

Objective:To analyze the implementation effect of case-based payment of patients undergoing senile cataract surgery,and to provide references for the reform of medical insurance payment.Methods:The patients undergoing senile cataract surgery in a grade-A tertiary hospital in Leshan city were selected as subjects.257 cases of the patients with case-based payment were taken as the policy group and 331 patients without case-based payment were taken as the control group during the same period.The average hospitalization cost,hospitalization days and cost structure of the two groups were compared to analyze the implementation and effect of the policy.Results:After the implementation of the policy,the average medical insurance expenditures and average out-of-pocket expenses of the policy group were lower than those of the control group(P<0.05).The medical insurance payment and patients'out-of-pocket expenses had decreased.However,the overspending cases exceeded 10.37%of the medical insurance quota standard,the lack of a timely adjustment mechanism for the cost standard resulted in the insufficient policy implementation at the hospital level and the motivation of medical staff was low.Conclusion:The implementation of the policy of case-based payment has achieved positive results.However,it is still necessary to establish a timely adjustment mechanism for disease-based cost standards,increase the constraints and guidance of policy and establish scientific and reasonable performance evaluation and incentives.