省级统筹视角下广东省门诊特定病种政策优化研究

Research on the Optimization of Specific Disease Outpatient Management Policy in Guangdong Province under the Perspective of Provincial Coordination

目的:分析广东省各地市高血压门诊特定病种政策差异,为广东省省级统筹工作提供可行建议。方法:通过整理广东省21个地市高血压门诊特定病种政策并梳理广东省高血压政策差异,利用广州市等10个地市的2019年门诊特定病种医保结算数据对比分析职工、居民的医疗费用水平和个人负担情况。结果:广东省各地市高血压门诊特定病种的病种管理、支付政策等方面存在保障形式和保障内容不同,二级目录控费效果不佳,部分统筹区待遇水平较低等情况。结论:广东省省级统筹工作应循序渐进,(1)规范病种名称和认定标准,制定统一的病种目录;(2)取消各地二级病种目录限制,统一全省支付范围;(3)进一步提升高血压待遇水平,降低患者疾病负担。在调整过程中应给予各地市过渡期,保留一定合理补偿,保障参保人权益和医保基金的平稳运行。

Objective:To analyze the policy differences of specific diseases in hypertension clinics in Guangdong Province,and to provide feasible suggestions for the provincial coordination.Methods:By sorting out the policies of specific diseases in hypertension clinics in 21 cities,combing out the differences in the policies of hypertension,using the report data of specific diseases in outpatient clinics in 10 cities including Guangzhou city,to compare and analyze the level of medical expenses of employees and residents and personal burden situation.Results:There are differences in the form of protection and the content of protection for specific diseases in hypertension,such as disease management,payment policies,etc.The effect of the secondary catalogue control fee is not good,and the treatment level of some cities is low.Conclusion:Guangdong Province’s provincial-level overall planning work should be carried out step by step.(1)to standardize the names and identification standards of disease,and to formulate a unified list of disease types.(2)to abolish the restrictions on the second-level catalogues and unify the scope of payment in the province.(3)to further improve the level of hypertension treatment and reduce the burden of patients.During the adjustment process,each city should be given a transition period,and reasonable compensation should be reserved to protect the rights and interests of the insured and the smooth operation of the medical insurance fund.