摘要
目前,国际上已有许多国家和地区实施了按病种付费制度,且基本都采用DRGs付费方式。而我国目前还处在单病种付费的试行阶段,各地病种付费的制度设计都较为简单,不利于按病种付费制度的长远推行。本文系统总结美国、德国、中国台湾医疗保险按病种付费的费用测算与支付方法,深入分析这三个地区在正常/异常病例界定,以及正常/异常病例的费用测算和支付标准制定方面的实际做法,为完善我国按病种付费的制度设计,促进按病种付费制度的高效运行提供借鉴。
Case payment, especially Diagnosis-related-group （DRG） payment, has been implemented in many countries for a long time, while it just emerged in our country. System design of case payment in various pilot areas is not e？ ective enough for the long-term operation. This paper summarized the cost calculation methods for case payment in U.S., Germany and Taiwan, including the identi？ cation and payment rate calculation of outliers/inliers respectively, to optimize system design of case payment for more e？ cient operation.
出处
《中国医疗保险》
2017年第11期69-72,共4页
China Health Insurance
