Bitcoin Forum
July 27, 2024, 10:28:06 PM
Welcome,
Guest
. Please
login
or
register
.
News
:
Help 1Dq create 15th anniversary forum artwork.
Home
Help
Search
Login
Register
More
Bitcoin Forum
>
Local
>
中文 (Chinese)
>
离题万里
>
按病种收费,能否“包”治百病
Pages: [
1
]
« previous topic
next topic »
Print
Author
Topic: 按病种收费,能否“包”治百病 (Read 98 times)
milltake
(OP)
Newbie
Offline
Activity: 21
Merit: 0
按病种收费,能否“包”治百病
January 11, 2018, 09:35:10 AM
#1
作为医改重头戏之一,医保控费开始打响2018年医改“第一枪”。近日广西、浙江、四川、河南等多个省份密集发布扩大按病种收付费范围的通知。据不完全统计,全国近三分之二省份已经实施或正试点实施按病种收费。
按病种收费,即从患者入院起,按病种治疗管理流程接受规范化诊疗,达到临床疗效标准后出院,整个过程中发生的诊断、治疗、手术等各项费用,都一次性打包收费。医院按此标准收费,医保基金和参保患者按规定比例付费。
其实按病种收费不是什么新事物,多年前,有些医院对于一些诊疗过程相对固定的疾病都已经实行了按病种收费,只不过,当时叫“包干治病”,比如针对剖宫产、阑尾炎等疾病。在国外,按病种收费的实践也证明,能降低整体的医疗费用。
两部分费用有望降下来
据报道,随着深度老龄社会的步步逼近,收少支多将成为医保基金的新常态。事实上,对于医保部门而言,开源空间并不大,费用控制也就成了医改一条必经之路。
按病种收费的目的就是控费。病人住院的总费用包括诊断、治疗、手术等各项费用,主要由床位费和护理费、检查和检验费用、药品及耗材费用、医生的诊疗费和手术费等部分组成。其中,床位费、护理费与医生的诊疗费和手术费相对固定,且有可能随着医改的深入出现上涨。所以,按病种收费主要针对的是检查和检验费用、药品和耗材费用。通过减少过度的检查和检验费用与不必要的药品和耗材费用,达到控制医疗费用的目的。
先看检查和检验费。目前的医疗环境下,医生最怕漏诊,完善检查和检验是减少漏诊的一个重要的方面。这部分费用只能在部分医院有减少的可能,对于一些大的医院,检查和检验很正规,尤其是经过近几年临床路径规范下的医院来说,检查和检验都有明确的规范,检查和检验的费用下降的空间其实不大。当然,有部分医院存在过度检查和检验的现象,按病种收费会明显压缩检查和检验的费用。
药品费用是病人住院的费用支出比较大的一部分。由于制度原因,医院普遍存在以药养医,以药补医的现象,随着药品零加成的推行,药品费用总体下降也是大势所趋。而耗材费用,对很多病人尤其是外科病人来说,占到住院总费用的很大一部分。通过按病种收费,这两部分费用也有望降下来。
可能造成医疗不足等问题
不过也要指出,从全球来看,每一种付费方式都是有利有弊的。按病种“打包”收费因为有一个总额硬杠杠,可能造成医疗不足等问题。
同样的疾病,病人自身的情况也会千差万别,按病种收费这种“一刀切”的模式,对于一些基础疾病多、病情复杂的病人而言,费用肯定不够,可能会出现医院选择性收病人的情况。这和医院一直推行的临床路径有着本质的区别,临床路径有明确的入组和退出机制,而按病种收费没有,势必会造成医院筛选病人。
药品方面,我国目前的情况,很多同一种化学名称的药品有多种,有进口药,国产药又分大小工厂生产的,不同厂家生产的药品疗效不尽相同。按病种收费后,可能会造成医院使用疗效较差的药品,从而造成患者治疗时间延长。或者某些特定药仍需要病人自费,导致病人整体费用并未下降。
至于耗材,问题同样不小。一些耗材的应用可以明显缩短手术时间,减少病人并发症的发生率,提高康复效果。按病种收费后,压缩耗材费用是必然的,医院可能因此减少部分必要耗材的采购量,造成治疗质量的下降;一些医院甚至会因耗材问题停止某些手术。前段时间部分省市出台严控耗材比例时,就已出现医院停止某些手术的情况。
按病种收费出发点很好,相信会起到一定的控制整体医疗费用的作用。但因此可能造成的一些负面问题也应当引起关注。规范治疗,提高医护人员诊疗费、手术费、护理费,降低药品、耗材的价格,提高国产药品、耗材的质量,才是控制费用的最终出路。
qiqiminmg
Newbie
Offline
Activity: 58
Merit: 0
Re: 按病种收费,能否“包”治百病
January 11, 2018, 10:21:07 AM
#2
换个方式捞钱
Pages: [
1
]
Print
Bitcoin Forum
>
Local
>
中文 (Chinese)
>
离题万里
>
按病种收费,能否“包”治百病
« previous topic
next topic »
Jump to:
Please select a destination:
-----------------------------
Bitcoin
-----------------------------
=> Bitcoin Discussion
===> Legal
===> Press
===> Meetups
===> Important Announcements
=> Development & Technical Discussion
===> Wallet software
=====> Electrum
=====> Bitcoin Wallet for Android
=====> BitcoinJ
=====> Armory
=====> Mycelium
=====> Hardware wallets
=> Mining
===> Mining support
===> Pools
===> Mining software (miners)
===> Hardware
=====> Group buys
===> Mining speculation
=> Bitcoin Technical Support
=> Project Development
-----------------------------
Economy
-----------------------------
=> Economics
===> Speculation
=> Marketplace
===> Goods
=====> Computer hardware
=====> Digital goods
=======> Invites & Accounts
=====> Collectibles
===> Services
===> Currency exchange
===> Gambling
=====> Games and rounds
=====> Investor-based games
=====> Gambling discussion
===> Lending
=====> Long-term offers
===> Securities
===> Auctions
===> Service Announcements
=====> Micro Earnings
===> Service Discussion
=====> Web Wallets
=====> Exchanges
=> Trading Discussion
===> Scam Accusations
===> Reputation
-----------------------------
Other
-----------------------------
=> Meta
===> New forum software
===> Bitcoin Wiki
=> Politics & Society
=> Beginners & Help
=> Off-topic
=> Serious discussion
===> Ivory Tower
=> Archival
===> Корзина
===> CPU/GPU Bitcoin mining hardware
===> Chinese students
===> Obsolete (buying)
===> Obsolete (selling)
===> MultiBit
-----------------------------
Alternate cryptocurrencies
-----------------------------
=> Altcoin Discussion
=> Announcements (Altcoins)
===> Tokens (Altcoins)
=> Mining (Altcoins)
===> Pools (Altcoins)
=> Marketplace (Altcoins)
===> Service Announcements (Altcoins)
===> Service Discussion (Altcoins)
===> Bounties (Altcoins)
=> Speculation (Altcoins)
-----------------------------
Local
-----------------------------
=> العربية (Arabic)
===> العملات البديلة (Altcoins)
=====> النقاشات
===> إستفسارات و أسئلة المبتدئين
===> التعدين
===> النقاشات الأخرى
===> منصات التبادل
=> Bahasa Indonesia (Indonesian)
===> Marketplace (Bahasa Indonesia)
===> Mining (Bahasa Indonesia)
===> Altcoins (Bahasa Indonesia)
===> Trading dan Spekulasi
===> Ekonomi, Politik, dan Budaya
===> Topik Lainnya
=> Español (Spanish)
===> Mercado y Economía
=====> Servicios
=====> Trading y especulación
===> Hardware y Minería
===> Esquina Libre
===> Mercadillo
=====> Mexico
=====> Argentina
=====> España
=====> Centroamerica y Caribe
===> Primeros pasos y ayuda
===> Altcoins (criptomonedas alternativas)
=====> Minería de altcoins
=====> Servicios
=====> Tokens (Español)
=> 中文 (Chinese)
===> 跳蚤市场
===> 山寨币
===> 媒体
===> 挖矿
===> 离题万里
=> Hrvatski (Croatian)
===> Trgovina
===> Altcoins (Hrvatski)
=====> Announcements (Hrvatski)
===> Off-topic (Hrvatski)
=> Deutsch (German)
===> Anfänger und Hilfe
===> Mining (Deutsch)
===> Trading und Spekulation
===> Projektentwicklung
===> Off-Topic (Deutsch)
===> Treffen
===> Presse
===> Altcoins (Deutsch)
=====> Announcements (Deutsch)
===> Marktplatz
=====> Auktionen
=====> Suche
=====> Biete
=> Ελληνικά (Greek)
===> Αγορά
===> Mining Discussion (Ελληνικά)
===> Altcoins (Ελληνικά)
=====> Altcoin Announcements (Ελληνικά)
=====> Altcoin Mining (Ελληνικά)
=> עברית (Hebrew)
=> Français
===> Actualité et News
===> Débutants
===> Discussions générales et utilisation du Bitcoin
===> Mining et Hardware
===> Économie et spéculation
===> Place de marché
=====> Échanges
=====> Produits et services
=====> Petites annonces
===> Le Bitcoin et la loi
===> Wiki, documentation et traduction
===> Développement et technique
===> Vos sites et projets
===> Hors-sujet
===> Altcoins (Français)
=====> Annonces
=> India
===> Mining (India)
===> Marketplace (India)
===> Regional Languages (India)
===> Press & News from India
===> Alt Coins (India)
===> Buyer/ Seller Reputations (India)
===> Off-Topic (India)
=> Italiano (Italian)
===> Guide (Italiano)
===> Progetti
===> Discussioni avanzate e sviluppo
===> Trading, analisi e speculazione
===> Mercato
=====> Mercato valute
=====> Beni
=====> Servizi
=====> Esercizi commerciali
=====> Hardware/Mining (Italiano)
=====> Gambling (Italiano)
===> Accuse scam/truffe
===> Mining (Italiano)
===> Alt-Currencies (Italiano)
=====> Annunci
===> Raduni/Meeting (Italiano)
===> Crittografia e decentralizzazione
===> Off-Topic (Italiano)
=> 日本語 (Japanese)
===> アルトコイン
=> Nederlands (Dutch)
===> Markt
===> Gokken/lotterijen
===> Mining (Nederlands)
===> Beurzen
===> Alt Coins (Nederlands)
===> Off-topic (Nederlands)
===> Meetings (Nederlands)
=> Nigeria (Naija)
===> Politics and society (Naija)
===> Off-topic (Naija)
=> 한국어 (Korean)
===> 대체코인 Alt Coins (한국어)
=> Pilipinas
===> Altcoins (Pilipinas)
=====> Altcoin Announcements (Pilipinas)
===> Pamilihan
===> Others (Pilipinas)
=> Polski
===> Tablica ogłoszeń
===> Alternatywne kryptowaluty
=====> Nowe kryptowaluty i tokeny
=====> Tablica ogłoszeń (altcoiny)
=> Português (Portuguese)
===> Primeiros Passos (Iniciantes)
===> Economia & Mercado
===> Mineração em Geral
===> Desenvolvimento & Discussões Técnicas
===> Criptomoedas Alternativas
===> Brasil
===> Portugal
=> Русский (Russian)
===> Новички
===> Бизнес
=====> Барахолка
=====> Обменники
===> Идеи
===> Кодеры
===> Майнеры
===> Политика
===> Трейдеры
===> Альтернативные криптовалюты
=====> Токены
=====> Бayнти и aиpдpoпы
===> Хайпы
===> Работа
===> Разное
===> Oбcyждeниe Bitcoin
=====> Новости
=====> Юристы
=> Română (Romanian)
===> Anunturi importante
===> Offtopic
===> Market
=====> Discutii Servicii
===> Minerit
===> Tutoriale
===> Bine ai venit!
===> Presa
===> Altcoins (Monede Alternative)
=====> Anunturi Monede Alternative
=> Skandinavisk
=> Türkçe (Turkish)
===> Bitcoin Haberleri
===> Pazar Alanı
===> Madencilik
===> Ekonomi
===> Servisler
=====> Fonlar
===> Proje Geliştirme
===> Alternatif Kripto-Paralar
=====> Madencilik (Alternatif Kripto-Paralar)
=====> Duyurular (Alternatif Kripto-Paralar)
===> Konu Dışı
===> Yeni Başlayanlar & Yardım
===> Buluşmalar
=> Other languages/locations
Loading...