[1]王明慧,陆广春.门诊特殊疾病医保支付方式及补偿水平研究[J].卫生经济研究,2018,(09):46-49.
　WANG Ming-hui,LU Guang-chun.Study on Payment Method and Compensation Level of Outpatient Special Medical Insurance[J].Journal Press of Health Economics Research,2018,(09):46-49.
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门诊特殊疾病医保支付方式及补偿水平研究
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卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
期数:
2018年09期
页码:
46-49
栏目:
医保天地
出版日期:
2018-09-04

文章信息/Info

Title:
Study on Payment Method and Compensation Level of Outpatient Special Medical Insurance
作者:
王明慧1; 陆广春1
1.华北理工大学，河北 唐山 063000
Author(s):
WANG Ming-hui; LU Guang-chun
North China University of Technology，Tangshan Hebei 063000，China
关键词:
门诊特殊疾病; 医保支付方式; 补偿水平
Keywords:
outpatient special disease;  medical insurance payment method;  compensation level
分类号:
R19
文献标志码:
A
摘要:
以A市为例，收集其门诊特殊疾病医保患者数据，分析门诊特殊疾病医保支付方式及补偿现状。结果显示，以总额预算为主的复合支付方式对分流门诊患者和提高医院工作效率起到了重要作用，“尿毒症”等10种疾病消耗了95%以上的门诊特病医保基金，是否在职、医院等级、慢性病患病时间等因素对门诊特病医保支付水平有显著影响。对此，提出相关建议： 适当增设一级及以下医疗机构为门诊特殊疾病定点医疗机构，适当平衡各类门诊特殊疾病统筹支付水平增长幅度，科学测算门诊特殊疾病单病种费用结算标准。
Abstract:
Taking City A as an example，this study collected data on medical insurance patients with special diseases in outpatient clinics，and analyzed the payment methods and compensation status of outpatient special diseases. The results showed that the compound payment method based on total budget played an important role in diverting outpatients and improving the efficiency of hospital work. 10 diseases such as "uremic disease" consumed more than 95% of outpatient special disease medical insurance funds. Factors including employment，hospital's grade，chronic disease duration have a significant impact on the level of medical insurance payment for outpatient special diseases. In this regard，the relevant suggestions were put forward：setting up medical institutions at the first level and below to set up medical institutions for special diseases in outpatient clinics，balancing the growth rate of the overall level of payment for special diseases of various outpatient clinics，and scientifically calculating the settlement standards for single disease types of outpatient special diseases.

参考文献/References:

[1] 段承阿鑫，常峰，路云.我国各省城镇职工基本医疗保险门诊特殊疾病政策比较研究[J].中国卫生事业管理，2017（5）:342-345.
[2] 郭志刚.社会统计分析方法——SPSS软件应用[M].北京:中国人民大学出版社，2005：152-157.
[3] 杜创.价格管制与过度医疗[J].世界经济，2013（1）:116-140.
[4] 胡宏伟，高敏，赵英丽，等.过度医疗行为研究述评[J].社会保障研究，2013（1）:46-52.

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更新日期/Last Update: 2018-09-05