住院按疾病诊断相关分组(Diagnosis Related Group,DRG)付费和门诊按人头付费等付费方式,在保障参保人员基本权益、提高医疗保障基金使用效率等方面取得积极成效.但是,对于慢性病和康复护理这类住院周期较长、病情复杂的患者而言,住院费用按DRG支付方式并不合理.文章从改革历程、支付方式和监管举措3个方面介绍美国和德国对长期住院病例付费的做法经验,并从实现价值医疗、体现个体差异、探索复合支付方式、提高数据质量、建立约束机制5个方面提出对我国的启示,以供我国康复护理等长期住院患者实施按床日付费改革参考借鉴.
Long-term Hospitalization Payment in the US.and Germany and the Enlightenment for Average Cost of Beds Based Payment in China
The payment methods,such as Diagnosis Related Group(DRG)for hospitalization and capitation for outpatient treat-ment,have achieved positive results in protecting the rights and interests of insured persons and improving the efficiency of the use of medical insurance funds.However,for patients with chronic diseases and rehabilitation nursing,the hospitalization period is long and the conditions complicated,and the payment method of DRGs is not reasonable.It analyzes the experiences of paying for long-term hospital cases in the US.and Germany from the aspect of reform process,payment method and regulatory measures.In order to pro-vide references for the reform of per-diem payment in rehabilitation nursing and other long-term hospitalized cases,it puts forward suggestions from aspects of realizing value care,reflecting individual differences,exploring complex payment methods,improving data quality and establishing constraint mechanism.
NETL
NSTL
万方数据
