医疗服务提供方对按病种定额付费政策的认知现状--以四川省成都市为例

摘要

Objective:To understand the implementation status of case-based payment among healthcare provid-ers and their cognition on the matter. Methods:Semi-structured interview was conducted on 30 purposely selected staff from 9 hospitals in Chengdu. Results:After one-year implementation of case-based payment, hospitals at different level carried out the policy vigorously:executed corresponding expense control measures and management. Neverthe-less, the proportion of cases that were paid with case-based payment was low, moreover the inclusion criteria for case was of disunity and the formulation of the expense standard was ambiguous to some extent. Conclusion:Certain achievements were accompanied with problems, so it is essential to refine reimbursement standards, improve case-based payment, make clear the inclusion criteria for case and extend the covering range of case-based payment in Chengdu. In addition, the medical insurance agency should strengthen the supervision of healthcare providers,and guide them to set up effective incentive mechanism.%目的：了解医疗服务提供方对按病种定额付费政策的认知现状，为进一步完善相关政策提供依据。方法：采用半结构式访谈方法，对9家医院38名工作人员和患者进行深入访谈。结果：各级医院积极执行按病种定额付费政策，并制定了相应的费用控制和管理措施，但各医院按病种定额结算的病例比例较低，在执行过程中存在着对病例纳入依据认识不一致、医疗服务提供方认为费用标准制定较为笼统等问题。结论：成都市按病种定额付费取得了一定成效，但也存在一些问题，需根据病种费用信息测算标准费用，完善按病种定额付费结算方式；进一步明确按病种定额付费病例的纳入依据和原则；逐步增加按病种定额付费疾病的种类；加强对医疗服务提供方的监管力度；引导医疗服务提供方建立有效的激励机制。