总额控制下的按病种分值付费评价--基于银川市的实践.pdfVIP

……-自 I I I I I @ 专题分析 总额控制下的按病种分值付费评价 一一基于银川市的实践 张↑毒 1 刘涛2 龚福玲2 (1宁夏社会保险事业管理局银川 750001 2银川市医疗保险事务管理中心银川 750001 ) 【 摘要】 2014 年，宁夏妥求各地级市逐步实施总额控制下的按病种分位付费方式。 2015 年，银川市先行 试点，一年来按病种分值付费遏制了医疗机构椎该病人的现象，主要医疗费用控制指标增幅明显下降，基于 《 疾病和健康问题国际分类 (ICD-10)) 的医保信息系统改造有利于促进医疗质量的管控，但如何因地制宜， 做好分级诊疗和异地就医结算政策衔接，进而在全自治区范围实施，还需妥管理者不断思考和探索。 关键词 】 支付制度改革;总额控制;按病种分位结算;收支平衡 【 【 中图分类号】 F840.684 C913.7 【 文献标识码 ] A ( 文章编号】 1674-3830 (2016) 7- 35- 4 doi:10.369/j.issn.1674- 3830.2016.7.007 Evaluating Payment by Disease Scores under Total B lUl g et C ontrol--Based on the 1 2 2 Pra.ctice ofYinchuan Zhang Bo ,Liu Ta0 ,Gong Fuling CNingxia Medical InsW ance Agency of Social @ Insurance Ad1l1inistrative Bureau, Ningxia, 75000 1;2Yinchuan Medical Insurance Affau.s Manage1l1ent Center, @ Yinchuan, 75000 1) ( Ab stract In 2014, it is required in Ningxia that a11 prefecture-level cities should gradually illlplement the policy of i1lSWance pa~严nent by disease scores under total budget control. In 2015, the pilot study was initiated in Yinchuan . After one year, the phenolllenon of refusing services m medical mstitutions has been prev ented, the grow1h of main ∞st- ndicators have been controlled. The illlprovement of the 1l1edicalulsWance ulfonnation systelll based on the Intemational Classification of Diseases a