精神疾病住院患者医保支付方式的国际经验及启示

International Experience and Enlightenment on Medical Insurance Payment Methods for Inpatients with Mental illnesses

英国、美国、瑞士等国家对精神疾病病例组合分组支付的研究较早,且运用较为广泛,能够为我国开展精神疾病住院患者医保支付方式改革提供参考:实施精细化的精神疾病病例组合按床日分组支付,科学设定病例评估指标进行分组并实现动态调整,收集质量数据,发展按价值付费,维护医保统筹基金和医疗机构运行平稳。

In countries such as the United Kingdom,the United States,and Switzerland,the study on case-mix grouping payment for inpatients with mental illnesses has been conducted earlier and widely used,which can provide reference for the reform of medical insurance payment methods for inpatients with mental illnesses in China.The article summarizes the experiences of implementing refined case-mix grouping payment for inpatients with mental illnesses based on bed days,scientifically setting case evaluation indexes for case mix grouping and at the same time achieving dynamic adjustment,collecting quality data,developing payment based on value,and maintaining the stable operation of medical insurance funds and medical institutions.