摘要
浙江省金华市借鉴急性后期医疗服务支付制度的国际经验,对康复护理医保支付方式进行实践探索。在建立与连续性医疗服务相适应的医保支付体系总体框架下,厘清康复护理服务的定位,并根据患者特征和服务重点,将康复护理划分为早期康复和中长期康护两种类型,分别基于功能相关分类法和患者导向模型设计相应的支付方式。同时,基于金华市医保历史数据,建立病例组合分组并测算支付标准,开发标准化评估量表及相应的信息系统,提升医疗服务质量的评价和监管水平,积极探索以患者健康结局为导向、医保支付与医疗服务质量评价结果相挂钩的激励约束机制,为我国建立科学合理的康复护理医保支付方式提供实证经验。
Jinhua City in Zhejiang Province,draws on the international experience of the payment system of medical services at post-acute stage,carried out practical exploration on the payment mode of medical insurance for rehabilitation nursing.Under the overall framework of establishing a medical insurance payment system suitable for continuous medical services,the orientation of rehabilitation nursing services was clarified,and according to patient characteristics and service focus,the rehabilitation nursing was divided into two types:early rehabilitation and middle and long term health care.The corresponding payment methods are designed based on function-related classification and patient-oriented model respectively.At the same time,based on the historical data of medical insurance in Jinhua City,the case-mix grouping is established and the payment standard is calculated,and the standardized assessment tool and corresponding information system are developed to improve the evaluation and supervision level of medical service quality.We will actively explore an incentive and restraint mechanism that is guided by patients'health outcomes and linked to the results of medical insurance payment and medical service quality evaluation.Provide empirical experience for our country to establish a scientific and reasonable payment mode of rehabilitation nursing medical insurance.
作者
胡琳琳
邵宁军
支梦佳
黄春芳
江小州
刘远立
HU Lin-lin;SHAO Ning-jun;ZHI Meng-jia;HUANG Chun-fang;JIANG Xiao-zhou;LIU Yuan-li(School of Health Policy and Management,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)
基金
中央高校基本科研业务费专项资金资助(3332020068)
国家自然科学基金资助(72034005)
中国工程院战略研究与咨询项目资助(2021-XZ-46)
泰康养老保险股份有限公司资助(tk-05000-2020-000354)。
关键词
急性后期
康复
护理
医保支付方式
post-acute
rehabilitation
nursing
medical insurance payment method
