摘要
结核病是患者因病致贫、因病返贫的重要原因,为减轻肺结核患者的经济负担,河南省于2018年下发《关于开展肺结核按病种付费工作的通知》。为总结政策实施的经验,发现存在问题,寻求解决方法,2022年,河南省通过现场调研评估、关键人物访谈及日常监测材料的汇总分析,对肺结核按病种付费政策进行评价。发现医保部门机构改革、医保部门对肺结核作为呼吸道传染病的认识不到位、基本医疗保障(医保)资金按照县(区)级统筹管理,软硬件系统成本高、结余部分由医疗机构留用的政策未落实等是肺结核按病种付费政策落实的影响因素。为此提出工作建议,提高对2035年消除结核病目标重要性的认识;实现医保资金按照地市级统筹管理;降低医保软硬件维护成本和加强县级定点医疗机构能力建设等。
Tuberculosis is an important factor causes the poverty or the return of poverty due to illness.In order to reduce the economic burden of tuberculosis patients in Henan province,the Notice on Carrying out Payment System Based on Diagnosis Related Groups(PSBDR)for Pulmonary Tuberculosis(PTB)was issued in 2018.In order to summarize the experience of policy implementation,identify existing problems,and seek solutions,in 2022,PSBDR for PTB was evaluated in Henan through onsite research and key person interviews,and monitoring data.The evaluation found that the institutional reform of the medical insurance department,inadequate understanding of tuberculosis as a respiratory infectious disease,coordinated management of medical insurance funding at the county(district)level,high cost of software and hardware systems,and the failure of implementing the policy for retaining the surplus funding used by medical institutions were the influencing factors for the implementation of PSBDR for PTB.It is suggested to raise awareness of the importance of the goal of End TB by 2035,realize the coordinated management of medical insurance funding at the prefecture levels,reduce the maintenance costs of medical insurance software and hardware,and strengthen the capacity building of county-level institutions.
作者
刘翠华
范昕彤
蒋建国
LIU Cuihua;FAN Xintong;JIANG Jianguo(Henan Center for Disease Control and Prevention,Zhengzhou,Henan 450016,China;The First Affiliated Hospital of Zhengzhou University)
出处
《现代疾病预防控制》
2023年第7期538-542,共5页
MODERN DISEASE CONTROL AND PREVENTION
关键词
结核病
按病种付费
基本医疗保障
工作建议
Tuberculosis
Payment based on diagnosis related groups
Basic medical care insurance
Work suggestions
