摘要
目的:恶性肿瘤治疗周期长、费用负担重,目前住院病例实施DRG付费存在医疗质量下降、费用转移等问题,而恶性肿瘤门诊慢特病按项目付费导致医保门诊支出快速增长,需探索科学支付模式,保证医保基金的价值支付。方法:通过文献资料及逻辑分析方法,对美国最新开展的肿瘤治疗模式进行总结介绍,为我国恶性肿瘤支付方面提供借鉴。结果:美国肿瘤治疗模式是多种保险支付方共同参与、多种支付方式结合的复合支付系统,利用绩效评价体系兼顾成本、质量和患者参与等指标,目标在于提高医疗质量,降低医疗成本。结论:我国恶性肿瘤支付也应利用基本医疗保险与商业保险等多种支付方,建立多层次医疗保障体系;建立复合支付体系,弥补单一支付方式存在的缺陷;同时完善考核评价体系,转变整体治疗模式,实现价值付费。
Objective To explore a scientific payment model of malignant tumor treatment to ensure the value payment of medical insurance fund.Methods Through literature and logical analysis methods,the latest cancer treatment model in the United States was summarized and introduced to provide reference for the payment of malignant tumors in China.Results The American cancer treatment model is a composite payment system with the participation of multiple insurance payers and the combination of multiple payment methods.The performance evaluation system is used to take into account the indicators of cost,quality and patient participation,with the goal of improving medical quality and reducing medical cost.Conclusion China's malignant tumor payment should also use multiple payers including basic medical insurance and commercial insurance to establish a multi-level medical security system.It is suggested to establish a compound payment system to make up for the defects of single payment method,improve the evaluation system,change the overall treatment model of cancer,and realize value payment.
作者
韩进松
吕传爱
左根永
Han Jinsong(Shandong Cancer Hospital,Shandong Cancer Institute,Jinan,P.R.China)
出处
《中国卫生事业管理》
北大核心
2024年第6期666-669,共4页
Chinese Health Service Management
基金
国家自然科学基金面上项目“我国农村地区慢性病患者分级诊疗的行为经济学模型及政策优化研究”(71774102)。
关键词
价值支付
肿瘤
医疗保险
value payment
oncology
medical insurance
