广东省按病种分值付费实践及对医院医保管理的启示

广东省积极推进按病种分值付费(Diagnosis-Intervention Packet,DIP)政策,驱动了医院管理的变革。介绍了广东省按病种分值付费试点城市的实践具有共同的核心环节,包括确定预算总额、建立病种分值库、设定医院权重系数等,并指出取得的成效和存在的问题。为适应这一医保支付方式改革,医院医保管理应主动求变,在准确掌握政策的基础上,做好优势病种遴选、提高病种诊疗的社会经济效益和优化基于按病种分值付费的临床路径管理是医院医保管理策略的重点。

Practice of the Diagnosis-Intervention Packet Payment in Guangdong and Its Enlightenments to Hospital Medical Insurance Management

The policy on DIP payment is implemented actively in Guangdong Province,driving the hospital management reform.The practice of the pilot cities in Guangdong Province to pay by disease points has a common core link which included the total budget,DIP grouping database,weight coefficient,settlement method and so on,and it points out the achievements and problems.It should take initiative to reform the hospital medical insurance management for adapting to the DIP payment.Based on the DIP payment,it is the strategy for the hospital medical insurance management to make great efforts to select advantageous diseases,obtain the social and economic benefits from disease treatment.The clinical pathway management based on payment by disease category is the focus of hospital medical insurance management strategy.