CAJ | 학술논문

目的控制医疗费用过快增长,探索建立适合新型农村合作医疗运行体制的按病种付费方式.方法以安徽省新型农村合作医疗试点县为现场.选取5病种3年全部资料进行实证研究,并对5病种就诊总费用中进入新型农村合作医疗支付范围的费用研究进行校正和定量分析.结果按病种"分段定额"付费的制度体系包括病种的选择、付费标准的测算、结算模式、补偿方式、监督控制措施五大方面.结论按病种"分段定额"付费是进行新型农村合作医疗医疗费用控制的有效模式,但其作用的发挥需要单病种临床路径的制定等五项配套措施的完善.
목적 공제의료비용과쾌증장,탐색건립괄합신형농촌합작의료운행체제적안병충부비방식.방법 이안휘성신형농촌합작의료시점현위현장.선취5병충3년전부자료진행실증연구,병대5병충취진총비용중진입신형농촌합작의료지부범위적비용연구진행교정화정량분석.결과안병충"분단정액"부비적제도체계포괄병충적선택、부비표준적측산、결산모식、보상방식、감독공제조시오대방면.결론 안병충"분단정액"부비시진행신형농촌합작의료의료비용공제적유효모식,단기작용적발휘수요단병충림상로경적제정등오항배투조시적완선.
Objective To refrain the medical costs from out-of-control increase, and identify a per-disease payment mode suitable for New-CMS.Methods Case studies were conducted on all the data of five diseases in the course of three years, in a field study of the pilot counties for NRCMS in Anhui Province.Results This system of per-disease "pay by segmentation and quota" is composed of five parts: choice of diseases, measurement of payment criteria, method of settlement, method of compensation, and methods of supervision.Conclusion This system is an effective way to keep the medical costs in the NRCMS under control, given an effective play of the five supportive measures including the clinical pathways for individual diseases.