两年一次!医保“打包付费”将实行动态调整|久久午夜神器
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本报讯 (记者张菁)为推进以按病种付费为主的多元复合式医保支付方式改革,国家医保局正式印发《医疗保障按病种付费管理暂行办法》(以下简称《办法》)。根据《办法》,我国将为医保按病种付费建立病种分组方案动态调整机制,原则上每两年调整一次。
医保按病种付费是指通过对疾病诊疗进行分组或折算分值,实行医保对医疗机构的“打包付费”。随着医疗技术的飞速发展,按病种付费也需要动态调整以适应临床变化。为此,《办法》提出,根据客观数据、意见建议、临床特征规律、政策调整变化等因素进行定期调整。
近年来,国家医保局着力推进住院医疗费用按病种付费,开展了按病组(DRG)和按病种分值(DIP)付费两项试点。DRG分组方案调整,在保持主要诊断大类相对稳定的基础上,重点调整核心分组和细分组;DIP病种库调整,重点包括核心病种和综合病种。
《办法》对按病种付费有关政策、关键技术、核心要素、配套措施等进行了明确,规范总额预算管理,要求合理编制支出预算,在此基础上确定按病种付费总额,强调总额预算的刚性。此外,《办法》还明确将按病种付费相关要求纳入协议管理,加强改革成效监测评估,强化基金监管,完善医保信息平台建设等,提升按病种付费的标准化水平。
国家医保局相关负责人表示,此次对医疗机构较为关心的按病种付费相关政策进行了明确,有利于引导医保医疗相向而行。值得关注的是,《办法》对医疗机构关心的“特例单议”机制独立成章,支持医疗机构收治复杂重症患者、合理使用新药耗新技术。申报特例单议的病例主要包括“因住院时间长、资源消耗多、合理使用新药耗新技术、复杂危重症或多学科联合诊疗等,不适合应用病种支付标准的病例”,对评审通过的病例,可按项目付费或调整支付标准,解除医院和患者的后顾之忧。
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