医疗保险基金支付方式改革对医疗质量的影响分析

摘要

探讨支付方式改革在医疗质量提升及医疗费用控制中的作用,以成都市门诊特殊疾病血液透析(门特血透)为例,分析了支付方式改革的必要性.目前,门特血透支付方式已从传统按项目付费过渡到按病种定额付费,以2014年成都市内两家收治患者情况类似的三级医院为例,模拟门特血透支付方式改革后的医院运行情况.探讨支付方式的改革可以间接督促医院医疗质量的提升和服务效率的提高.应在广泛准确收集数据的基础上,根据门特血透质效评价结果对医疗机构实行按医疗质量付费.%To explore the influence of medical insurance payment reform on medical quality enhancement and medical cost control,this study analyzed the significance of medical insurance payment reform on hemodialysis among outpatients with specific disease in Chengdu.At present,the payment of hemodialysis for outpatient specific diseases has been changed from Fee for Service (FFS) into Fee for Diseases Related Groups.Taking two hospitals with similar diseases of patients as example,the results in these two hospitals after medical insurance payment reform in 2014 were simulated.Medical insurance payment reform could indirectly supervise medical quality and enhance service efficiency.In the future,based on widely data collection,medical insurance payment could be changed into Fee for Medical Quality according to the cost-effectiveness analysis results.