我国安宁疗护按床日付费政策进展与发展建议

Progress and Development Suggestions on the Policy of Payment by per Bed-day for Palliative Care in China

目的:梳理2017年以来我国安宁疗护各试点地区按床日付费相关政策文件,为完善安宁疗护支付政策提供科学依据。方法:从地区分布、机构覆盖范围、患者准入标准、床日付费标准、最高付费期限、医保支付情况六个方面整理分析各试点地区安宁疗护支付政策。结果:我国安宁疗护按床日付费试点以小范围典型机构为主,患者准入以终末期恶性肿瘤患者为主,按床日付费标准相对较低,最高付费期限以90天和180天为主,多数纳入基本医保参保对象。结论:安宁疗护按床日付费制度尚需完善,建议扩大按床日付费试点范围,厘清患者准入标准和基本服务项目内容,科学制定按床日付费标准并提高医保支付比例,促进安宁疗护服务可持续发展。

Objective To sort out the policy documents related to payment by per bed-day for palliative care in each pilot region in China since 2017,and to provide scientific basis for the improvement of palliative care payment policy.Methods From regional distribution,institutional coverage,patient access standards,payment standards by per bed-day,maximum payment period,health insurance payment,palliative care payment policy in each pilot region was organized and analyzed.Results The pilot program of payment by per bed-day for palliative care was dominated by typical institutions in relatively few areas,patient access was dominated by patients with end-stage malignant tumors,payment standard by per bed-day was relatively low,the maximum payment period was dominated by 90 and 180 days,most of which are included in the basic health insurance enrollment.Conclusion The payment system by per bed-day for palliative care needs to be improved,and it is recommended to expand the pilot scope of payment by per bed-day,clarify the patient access standard and the content of basic services,scientifically formulate payment standard by per bed-day and increase the proportion of medical insurance payment,so as to promote the sustainable development of palliative care.