摘要
目的探索肺结核门诊辅助诊疗单病种全额付费在湖南省实施的可行性。方法通过问卷调查和电话访谈的方式,了解全省131个县(市、区)肺结核门诊医疗保障的现状;通过现场访谈的形式,调查10个县(市、区)新型农村合作医疗(简称"新农合")部门和疾病预防控制机构(简称"疾控机构")共40名工作人员对"单病种付费"实施利弊的看法。结果湖南省131个县(市、区)中有118个将肺结核门诊纳入了新农合报销,报销方式分为按比例报销、按额度报销和按病例包干定额付费3种,但报销比例(30%～80%)和额度(每例200～1500元/年)存在较大差别;根据省级指导标准,全省各非试点县(市、区)尚需每年增加1014万元肺结核门诊医疗保障。调查的6个试点县中,2个县试点前后基金负担无明显变化(增加幅度介于-5%～5%),3个县略有增加(增加幅度介于5%～10%),1个县显著增加(增加幅度10%以上)。结论肺结核门诊辅助诊疗单病种付费政策可以因地制宜地在湖南省逐步推广实施。
Objective To explore the feasibility of implementing case-based payment for outpatient tuberculosis auxillary diagnosis and treatment in Hunan province.Methods All 131 counties of Hunan province were investigated to obtain the current situation for medical insurance of tuberculosis patients by questionnaire survey and telephone interview.Forty staffs of 10 counties from the new rural cooperative medical system（NRCMS） sectors and centers for disease control and prevention（CDC） were interviewed on the pros and cons of pilot case-based payment for outpatient tuberculosis.Results Outpatient TB treatment fee was covered by NRCMS in 118 counties.Reimbursement approaches consist of proportional reimbursement,fixed amount reimbursement and case-based reimbursement.However,the fixed amount reimbursement varies from 200 to 1500 Yuan per case and the proportional reimbursement has a range of 30%-80%.According to the provincial guidance of basic service package,at least 10.14 million Yuan per year need to be input to NRCMS for non-pilot counties to implement the case-based payment policy.Among 6 investigated pilot counties,NRCMS＇ fund burden did not show obvious change（increasing by-5%～5%）in 2 counties,slight increase（by 5%-10%） in 3 counties,but significant increase（over 10%）in 1 county after pilot carrying out.Conclusion The policy of case-based payment for outpatient TB auxiliary diagnosis and treatment can be adapted to local conditions,and gradually expanded and promoted in Hunan province.
出处
《中国防痨杂志》
CAS
2012年第12期780-783,共4页
Chinese Journal of Antituberculosis
基金
世界卫生组织资助课题(CHN/10/STB/005520)
中国全球基金结核病项目实施性研究课题(TB 10-003)
关键词
结核
肺
门诊医疗
单付费者系统
可行性研究
湖南省
Tuberculosis
pulmonary
Ambulatory care
Single-payer system
Feasibility studies
Hunan province
作者简介
通信作者：张贻瑞，Email：yirui_2002@hotmail．com
