医保支付方式改革下病种点数法对我国分级诊疗的影响

为实现病种点数法良好地促进我国分级诊疗的发展,在理清点数法的内涵及其与分级诊疗的内在逻辑关系后,发现病种点数法在控制医疗费用、提高医疗质量等方面具有重要的作用,但也存在不利于基层首诊、患者分流以及基层医疗机构发展等问题,从而制约我国分级诊疗目标的实现。建议实行点数法的过程中要以病种分布为依据进行医疗机构的分值设置,减少不同级别医疗机构间医疗质量的差异,并促进医疗机构转变绩效管理模式以适应点数法的新要求,全方位入手建立适应分级诊疗新格局的医保支付方式,助推我国分级诊疗的实现。

Influence of the Disease Point Method on the Hierarchical Diagnosis and Treatment in China Under the Reform of Medical Insurance Payment Method

In order to realize the development of hierarchical diagnosis and treatment in China,the paper summarizes the connotation of the point method and its intrinsic logical relationship with hierarchical diagnosis and treatment,and finds that the disease point method has the advantages of controlling medical expenses and improving medical quality.But there are also problems,such that the disease point method is not conducive to the primary diagnosis of the primary level,patient diversion and the development of primary medical institutions,which restricts the realization of the goal of hierarchical diagnosis and treatment in China.Therefore,the paper proposes that in the process of implementing the point method,the scores of medical institutions should be set on the basis of disease types,the differences in medical quality between medical institutions at different levels should be reduced,and the medical institutions should be transformed into performance management models to adapt to the new requirements of points.Medical insurance payment method that adapts to the new pattern of hierarchical diagnosis and treatment should be established,and the realization of hierarchical diagnosis and treatment in China be promoted.