按病种收费应慎重推行

有关部门试图通过推行按病种收费这一收费方式改革,来解决看病贵这一顽症.本文通过对这一收费方式的分析,总结出按病种收费不仅不能解决看病贵,而且还会引发一些新的矛盾和问题,建议有关部门应慎重推行.     

按病种收费应慎重推行

为解决“看病贵”,2004年8月,卫生部选择天津、辽宁、黑龙江、山东、河南、陕西、青海作为全国开展按病种收费管理试点省市,拉开医疗服务收费方式改革的序幕。2006年,卫生部、国家发改委等部门联合下文,要求二级以上医院开展单病种限价试点。至此,按病种收费在全国全面铺开。但是,笔者认为按病种收费应慎重推行。     

国内外医疗收费模式比较研究

面对“看病难、看病贵”问题，政府和医疗机构都在积极探索解决的办法。本文通过对现行的医疗收费模式的比较、分析，认为按病种收费模式是我国医疗收费的发展方向。目前，单病种限价收费为按病种收费模式的推行积累了经验。     

香港公立医疗服务按单元收费进展及其启示

通过总结香港地区按服务单元收费的经验和进展,提出我国内地地区推行按病种付费同时完善按服务单元收费的政策建议,并提出采用服务收费标准靠近成本的原则制定收费价格并且定期审核服务成本与定价的建议,为我国推行医保支付方式改革提供参考。     

实行单病种收费的经验和体会

近年来,医疗费用不断上涨,"看病难"、"看病贵"问题日益成为社会各界和人民群众普遍关注的热点问题,也是困扰医院发展的一个重大难题。为解决这一问题,我院在调查研究和试点的基础上,在浙江省衢州市率先对外科系统的19个病种施行单病种收费工作,并在推行的过程中不断加以完善。此举大大降低了患者的就医门槛,减轻了医保部门的医疗保险基金经费支出,收到了良好的社会效益。     

腹腔镜胆囊切除术住院标准流程的可行性研究

近年来已有部分省市实施了“按病种限价”的政策来解决城乡居民“看病难、看病贵”的问题。按病种收费,减轻人民群众的经济负担是大势所趋。如何提高医疗服务的质量、安全和效率,减少医疗服务成本,且在降低医疗费用的同时增加医院的     

单病种限价收费的利弊分析

看病贵，是近年来人民群众反映强烈的问题之一。目前，我国医疗机构在收费上采用的是按项目收费办法，这种收费办法所带来的高管理成本和费用的不可控性一直为业内诟病。在我国基本医疗保险覆盖面很低、商业医疗保险还不发达的今天，按病种付费是一种能够有效控制费用且能相对较好地保证参保人员权益的支付方式。     

运用临床路径推算单病种限价收费的探讨

面对人民群众"看病贵"的呼声,很多地区和医院都采用单病种限价来控制医疗费用的不合理上涨.单病种限价即平常所说的按病种收费,这是很多国家用来控制医疗成本的一种医疗付费方式.实行按病种收费,医院必须运用临床路径管理思维详细设计疾病的临床治疗方案,包括常规诊疗、手术方法、手术中使用的材料、住院时间等细节,病人在治疗前就可对治疗中要做哪些检查,该用什么药物一目了然,并比较费用高低选择合适的医院.     

新型农村合作医疗付费方式现状研究

我国新型农村合作医疗在开展过程中,对于费用的支付主要有两种方式,一种是按服务项目收费,一种是按病种收费,笔者采用文献综述的方法对两种支付方式的现状进行了分析,可对未来新农合管理部门选择何种支付方式起到一定的借鉴作用.     

多元化医保支付方式对医院管理能力的影响

随着国家医疗卫生的改革的不断深入,社会医疗保障体系逐步完善,全民医保网络初步形成,也实现了医保支付方式多元化发展。医保制度改革的目的就是促进社会保障体系正常运行,以进一步控制医疗费用的增长幅度,解决人们"看病难""看病贵"的问题。医保支付制度的改革使按服务项目收费、按服务单元收费、按病种付费、按人头付费以及按预算总额付费等多元化医保支付方式与现行医保制度相适应,逐步增强医务人员的管理责任意识,合理调整医院各科室组成部分,进而有效提升公立医院的服务质量及整体管理水平,促使医院发展更规范、更理性。     

实行单病种限价收费利弊的探讨

为切实解决群众“看病难、看病贵”的问题,有效控制医药费用,这些年,各地陆续开展医疗服务价格改革,进行了一系列有益的探索,其中单病种限价收费方式不失为一种有益的尝试。本文探讨了单病种限价收费的积极影响与存在的弊端,为医院完善单病种限价收费制度提供理论依据。     

Mortician cleared in dispute over fee for AIDS burials

A Baltimore County Circuit judge ordered the Maryland State Board of Morticians to reimburse the Lassahn Funeral Home for sanctions incorrectly imposed in 1990, when Frederick Petrich asked Lassahn to make funeral arrangements for a terminally-ill AIDS patient. When Lassahn explained that a $450 fee would be imposed for special handling for infectious disease Petrich filed a complaint with the State Board of Morticians. The Board brought discrimination charges against the funeral home and Ronald C. Lassahn for charging this special fee. Lassahn won his case since the 1990 State law did not require morticians to follow universal precautions. Lassahn stopped charging the special fee in January 1992, six months before the State mandated the use of universal precautions. Lassahn was awarded the maximum of $10,000 as reimbursement of fees and expenses.     

User charges and priority setting in health care: balancing equity and efficiency

User charges are the major source of finance for many health care systems. However, traditional approaches to health care priority setting, such as cost-effectiveness analysis, usually assume there are no user charges and therefore may ignore important implications for equity and efficiency. This paper therefore develops a rudimentary model of priority setting in which the fixed health care budget can be augmented by user charges. The paper uses methods analogous to models of optimal commodity taxation to develop a set of rules for the inclusion of a health technology in the subsidized health care package, and the calculation of its associated copayment rate. The results indicate that optimal levels of subsidy depend on the cost-effectiveness of the intervention, its price elasticity of demand, the epidemiology of the associated disease, and the policy maker's attitude towards equity. The model has important implications for policy making in three domains: health care priority setting, evaluation of health care technologies, and charging policy.     

Charging for library and information services in medical libraries: a review of the literature and a survey of current practice

A summary of some of the issues concerned with charging for library services (particularly information services and services provided by medical libraries) is given. The results of a survey carried out in July 1992 are presented. The survey asked respondents to indicate which library services they charged for, the level of charges and the extent to which charges to those outside the organization and those within it differed. Twenty-five libraries (response rate of 69%) replied to the survey. Some further areas for research and discussion are indicated.     

Informal economic activities of public health workers in Uganda: implications for quality and accessibility of care.

This paper reports the results of a study in Uganda of the 'informal' economic activities of health workers, defined as those which earn incomes but fall outside official duties and earnings. The study was carried out in 10 sub-hospital health facilities of varying size and intended role and used a variety of quantitative and qualitative methods. The paper focuses on those activities which are carried out inside public health facilities and which directly affect quality and accessibility of care. The main strategies in this category were the leakage of drug supply, the informal charging of patients and the mismanagement of revenues raised from the formal charging of patients. Few of the drugs supplied to health units were prescribed and issued in those sites. Most health workers who have the opportunity to do so, levy informal charges. Where formal charges are collected, high levels of leakage occur both at the point of collection and at higher levels of the system. The implications of this situation for the quality and accessibility of services in public health facilities were assessed. Utilisation levels are less than those expected of the smallest rural units and this workload is managed by a handful of the expected staff complement who are available for a fraction of the working week. Even given these few patients, drugs available after leakage were sufficient to cover less than half of those attending in most facilities. Evidence on staff motivation was mixed and better motivation was associated with better performance only in a minority of units. Informal charging was associated with better performance regarding hours worked by health workers and utilisation rates. Drug leakage was associated with worse performance with respect to both of these and unsurprisingly, with drug availability. Short term strategies to effect marginal performance improvements may focus on the substitution of strategies based inside health units (such as informal charging) for those based outside (facilitated by drug leakage). In the long term, only substantially higher funding of the sector can be expected to facilitate major change, but alone will be insufficient. Investment strategies supported by appropriate policy development has to be informed by understanding and monitoring of the 'informal' dimension of health sector activity.     

Managerial perceptions of the incentives inherent in National Health Service capital charging.

Capital charging was introduced into the National Health Service (NHS) in 1991 in order to stop capital being treated as a 'free' good and to encourage managers to use their assets more efficiently. This article seeks to examine the extent to which managerial thinking has been influenced. It uses as evidence interviews with NHS managers conducted in Scotland in 1994. The following uses of capital charges data are explored: capital programme; disposal programme; maintenance programme; contract pricing; and budgetary devolution. New capital programmes required more justification and capital charges were seen as relevant to estate rationalization. Less effect was found with regard to the maintenance programme, though this may have been due to a downgrading of the estates function in most Trusts. Although the capital charge costs included in contract prices affect the competitive position of providers, there was criticism of the lack of development of the purchasing function. Budgetary devolution was proceeding relatively slowly but, among those Trusts which had devolved capital charges, evidence was found that some clinicians were becoming aware of the full costs of equipment use. This article concludes, with cautious optimism, that capital charges are beginning to influence decisions and that, despite some incentives being dysfunctional, they will lead to a better managed NHS.     

军队医院医疗收费损失及会计核算处理

军队医疗单位收费损失是指军队医院开展对外医疗活动中,理应收取而实际未能收到的部分医药收入。从目前实际情况看,军队医院医疗收费损失主要有减免、退费、欠费、逃费、漏费等,由于各种原因,医疗收费损失在所难免。规范收费损失处理业务,客观真实地反映财务收支状况及结果,有利于医疗和收费人员加强收费管控,为优化经济效果服务。     

Unwinding the State subsidisation of private health insurance in Ireland

Ireland's private health insurance market provides primarily supplementary health insurance for hospital services, operating alongside a public hospital system to which residents have universal access entitlements, subject to some copayments for those without a medical card. The State subsidises the purchase of private health insurance through measures including tax relief on premiums and not charging the full economic cost for private beds in public hospitals. Furthermore, privately insured patients occupying public beds in public hospitals did not, until 2014, incur charges for such accommodation, apart from modest statutory charges. In the Budget in October 2013, a number of measures were announced that began to unwind these subsidies. Although it was initially feared that these measures would add to premium inflation, leading in turn to further discontinuation of health insurance, the evidence suggests that premium inflation has eased and take-up has stabilised, although some of this may have been due to the introduction of lifetime community rating in May 2015. Nevertheless, it would appear that the restriction on the subsidisation of private health insurance has not had a significant adverse effect on the market, while it has reduced an inequitable cross-subsidy.     

Patients' attitudes to co-payments for general practitioner services: do they reflect the prevailing system?

OBJECTIVES: Most Organisation for Economic Co-operation and Development (OECD) countries have introduced cost-sharing. This study compares the views of patients who are used to a service that is free at the point of delivery with those who are used to a system where 70% of patients pay for consultations. METHODS: Secondary analysis of survey data from a random sample of 11,870 patients in Northern Ireland and the Republic of Ireland. RESULTS: A 52% response rate was achieved, though respondents were representative of the two populations. Attitudes generally reflected the national status quo with little support for co-payments where there was currently no charging, but broad support where charging was established. Charging for missed appointments would be supported where there were delays in getting an appointment. CONCLUSIONS: More research is needed to understand what underlies support for, or opposition to, charges. However, it is apparent that patients' opinions need to be considered when formulating health care policy.     

医院信息化中收费问题的研究

目的：研究医疗收费过程中遇到的问题,主要是如何自动区分缴费主体。方法：基于“军卫一号”软件实际应用情况,分析了国内医疗收费的现状,设计了单病种收费机制和能普遍适应各种医保政策的收费机制,并描述其费用分解流程。结果：费用分解流程能够很好地适应国内各地不同的医疗支付政策,具备高度的灵活性,并在解放军总医院新版门诊收费系统中获得成功应用。结论：解决了医疗收费中常见的主要问题,其费用分解流程在国内各地区复杂多变的支付政策环境下具有普遍适应性。