新增工伤康复服务项目遴选及支付标准探索*

通过梳理工伤康复服务项目规范与支付标准制定等相关政策，阐述“国家版”和“广东省版”工伤康复服务项目和支付标准制定情况，分析新增工伤康复服务项目管理现状。选择广东省40家协议医院为样本，基于专家咨询法，计算专家采纳率，建立新增工伤康复服务项目目录，并通过基准项目赋值定价，为新增工伤康复服务项目遴选及支付标准提出管理措施。文章建议进一步细化新增工伤康复服务价格项目立项审批流程，建立新增工伤康复服务项目管理办法，规范管理制度。探索新增工伤康复服务项目纳入工伤保险目录管理机制，同时，充分发挥行业学会或协会的作用，加强卫生技术评估准入评审与价格制定管理决策中的广泛应用。

Discussion on the Selection and Payment Standards of New Work-Related Injury Rehabilitation Services

Objective: To discuss the selection of and the management of payment standards by sorting out relevant policies such as work-related injury rehabilitation service item specification and payment standard formulation. Methods: 40 contracted sample hospitals in Guangdong Province were selected as the research objects. Based on the expert consultation method, the adoption rate of experts was calculated to select the newly added work-related injury rehabilitation service items and determine the payment standard through the assignment of benchmark items. Results: According to the list of 41 new work-related injury rehabilitation service items collected by the sample hospitals, 19 new medical service items were selected and determined through expert consultation, sorted according to the adoption rate of experts from high to low, and combined with the exclusion criteria. The adoption rate of 4 items is greater than 80 %. According to the results of Model 2 of the correspondingly assigned benchmark items, the proposed payment standard for the newly added work-related injury rehabilitation service items is determined. Conclusion: The selection of new work-related injury rehabilitation service items and the establishment of payment standards can enrich the price system of work-related injury rehabilitation services and promote the high-quality development of work-related injury rehabilitation, so as to provide method reference for the new selection of medical service projects.