摘要
2014年,宁夏要求各地级市逐步实施总额控制下的按病种分值付费方式。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推诿病人的现象,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,还需要管理者不断思考和探索。
In 2014, it is required in Ningxia that all prefecture-level cities should gradually implement the policy of insurance payment by disease scores under total budget control. In 2015, the pilot study was initiated in Yinchuan. After one year, the phenomenon of refusing services in medical institutions has been prevented, the growth of main cost- ndicators have been controlled. The improvement of the medical insurance information system based on the ＂International Classification of Diseases and Health Problems（ICD-10）＂ has made contribution to promoting the supervision of medical service quality. But how to make it suitable for local conditions, to make the policy of classified diagnosis and treatment connected with remote medical settlement, and then to be implemented in the whole autonomous region, need managers keep thinking and exploration.
出处
《中国医疗保险》
2016年第7期35-38,共4页
China Health Insurance
关键词
支付制度改革
总额控制
按病种分值结算
收支平衡
reform of payment system
global budget
settlement by disease score
balance of payments
