一体化诊疗路径与支付方式改革实践

Integrated care pathway and payment reform: practices in China

介绍了一体化诊疗路径与支付方式改革项目在试点地区实施干预的具体措施,试点项目选择了脑卒中和慢性阻塞性肺疾病两大类疾病,探索项目实施对医疗服务行为和医疗费用的影响,认为单病种打包定额付费制度对于临床路径管理的实施是把双刃剑;规范医疗行为需要政府、医疗保险部门、医疗机构、医务人员和患者长期的共同努力;医疗费用总量增长是客观规律,关注费用构成才是提高医保资金使用效率的正确出路.

A description of the intervention measures of the reform program for integrated care and payment in pilot areas,covering such diseases as chronic obstructive pulmonary disease and cerbral stroke.The reform aims at exploring impacts on both medical behaviors and medical costs.Authors of the paper hold that the practice of packaged ceiling payment for a single disease is a two-edged sword for clinical pathway management,and joint efforts by the government,medical insurers,medical workers and patients at large are required to regulate medical behaviors over time.They also see the total growth of medical costs as an objective rule,and the correct way out for optimal use of medical insurance funds is to focus on makeup of such costs.