价值导向型医保付费政策效果探讨——基于柳州市中医优势病种的实证分析

Discussion on the Effect of Value-Oriented Medical Insurance Payment Policy——Based on Empirical Analysis in Liuzhou

目的:评估按疗效价值付费的政策效果。方法:选取6个病种的患者作为研究对象,从医疗质量、成本和患者体验三个维度对柳州市中医优势病种按疗效价值付费的政策效果进行探讨。结果:柳州市中医优势病种按疗效价值付费政策具有低成本、高疗效和体验好的特点,但也存在住院时间过长、可选病种十分有限等问题。结论:柳州市应重点推进信息化建设,以可操作性为前提选择病种实行按疗效价值付费,并构建多维的医疗质量评价体系。

Liuzhou City is experimenting with the reform of traditional Chinese medicine conservative treatment based on the mean value of the local disease group.This study is based on the practice and exploration of value-based payment for dominant diseases of traditional Chinese medicine in Liuzhou City.Patients with six diseases(clavicle fracture,distal radius fracture,proximal humerus fracture,humeral shaft fracture,tibiofibular fracture,simple thoracolumbar fracture)were selected as participants.This study explored the effect of the policy of pay-as-you-go and evaluated the feasibility of the policy of pay-by-valuefrom from three dimensions:medical quality,cost and patient experience.It was found that in terms of medical quality,the clinical efficacy and safety indicators of the six fracture diseases were basically the same,but the average length of hospitalization for conservative treatment in traditional Chinese medicine was prolonged by 2.58 days.In terms of cost,the average hospital cost of a patient was about one-third of the surgical treatment.In experience,patients had higher satisfaction with the efficacy,rehabilitation guidance and overall evaluation of conservative treatment of traditional Chinese medicine.Liuzhou Medical Insurance Traditional Chinese Medicine conservative treatment according to the local average disease group payment policy has the characteristics of low cost,high efficacy and good experience,but the current length of hospitalization and the choice of diseases were very limited.In view of these,Liuzhou should focus on the reform of information construction,the selection of disease types based on operability,and the construction of a multidimensional medical quality evaluation system.