基于项目人次权重的日间手术病种费用支付标准研究——以甘肃省为例

Study on the Payment Standards for Costs on Daytime Surgical Disease Based on the Importance of People in Project:Taking Gansu Province as an Example

目的探讨48种典型日间手术病种费用支付标准,为广泛实施的日间手术提供一个科学、合理的医保支付标准,引导日间手术规范化实施。方法梳理和分析国内日间手术政策和标准临床路径,归纳48个病种日间手术的规范临床路径;分析甘肃省部分医疗机构医保结算数据,提取和分析数据特征;确定项目人次权重和比较历史样本数据得出日间手术费用支付标准。结果通过医保数据分析、项目权重确定及标准费用测算、组织专家研讨,最终得出科学合理的日间手术病种费用支付标准。结论基于项目人次权重的日间手术病种费用支付标准,能较全面地反映当前日间手术费用水平,对优化医疗卫生机构日间手术资源配置、保障医保基金安全以及推动日间手术规范化实施具有重要意义。

Objective To explore the payment standards for 48 typical daytime surgical diseases,provide a scientific and reasonable medical insurance payment standard for widely implemented daytime surgeries,and guide the standardized implementation of daytime surgeries.Methods Sort out and analyze domestic daytime surgery policies and standard clinical pathways,summarize 48 standardized clinical pathways for daytime surgery of diseases,analyze medical insurance settlement data of some medical institutions in Gansu Province,extract and analyze data characteristics.Determine the importance of project personnel and compare historical sample data to determine the payment standards for daytime surgical expenses.Results Through analysis of medical insurance data,determination of project importance,calculation of standard costs,and organization of expert discussions,a scientifically reasonable standard for payment of daytime surgical disease expenses was ultimately obtained.Conclusion The payment standard for daytime surgical expenses based on the importance of project personnel can comprehensively reflect the current level of daytime surgical expenses,and is of great significance for optimizing the allocation of daytime surgical resources in medical and health institutions,ensuring the safety of medical insurance funds,and promoting the standardized implementation of daytime surgery.