我省试点7种大病“限价收费” The pilot province seven kinds of serious illness“Price charge”

江苏医保付费方式改革启动，所限价格是与医疗机构“议价”确定，7种大病均有详细诊疗方案可查 Jiangsu medical insurance payment reform start，The limit of the price is and medical institutions“bargaining”determine，Seven kinds of a serious illness diagnosis and treatment are detailed scheme can be checked

　　为减轻参保人员负担、激励定点医疗机构降低医疗成本，江苏推出了医保付费新方式，即按病种限价结算。根据江苏省人社厅、省卫生厅、省民政厅和省物价局联合制定的《江苏省开展城镇基本医疗保险部分重大疾病按病种收付费试点工作实施方案》(以下称《实施方案》)，患有儿童白血病等7种大病的医保患者，不管最后医药费花了多少钱，出院时只要交付个人部分就行，多“花”的钱由医院和医保机构结算。不仅如此，省人社厅还表示，下一步，将在试点的基础上，优先选择临床路径明确、并发症与合并症少、诊疗技术成熟、效果可控而且费用稳定的常见病、多发病纳入其中。

In order to alleviate ginseng protect personnel to burden、Incentive fixed-point medical institutions to reduce medical cost，Jiangsu launched a new way for medical insurance，Namely press disease to price settlement。According to the jiangsu province people club hall、Province health department、Provincial civil administration office and provincial price bureau jointly formulate the《Jiangsu province town of basic medical insurance major disease press disease to pay the pilot work plan》(Hereinafter referred to《Implementation plan》)，With childhood leukemia and 7 kinds of medical insurance patients of a serious illness，No matter how much the medical expenses，The hospital as long as delivery individual part will do，more“flower”Money by hospitals and medical insurance institution settlement。Not only that，Provincial people club hall also said，The next step，In the basis of the pilot，Preference clinical path clearly、Less complications and complications、Treatment technology mature、Effect controlled and cost stable common diseases、Included in the frequently-occurring disease。

5问医保付费新政 5 q medical insurance pay for the New Deal

1，为什么要推行大病付费方式改革？ 1，Why to conduct a serious illness payment reform？

因为医疗费用中比重较大的检查费、仪器费等没得到有效控制 Because the medical expenses in a larger share of the inspection fee、Instrument fee, so don't get effective control

　　省人社厅有关负责人表示，传统“按项目付费”方式具有天然的诱导服务的弊端，特别是在当前的医疗服务价格不能充分体现医务人员技术价值的情况下，这种支付方式是推高医疗费用、浪费卫生资源、扭曲医疗行为的一个因素。“这次，我们医保部门发挥了4000多万参保成员的团体优势，跟医院‘讨价还价’，变被动为主动，也是为了规范医疗服务行为，控制医疗费用不合理增长，提高医疗保险待遇的水平。”

Provincial people club hall officials said，The traditional“According to the program pay”Way has the disadvantages of natural induced services，Especially in the current medical service price can not fully reflect the medical staff technology under the condition of value，This kind of payment are pushed high medical costs、Waste of health resources、Distortion medical behavior of a factor。“the，Our medical insurance department played more than 4000 ginseng protect a member of the group advantage，With hospital‘bargaining’，Become the passive to active，Also in order to standardize the medical service behavior，Control medical cost is not reasonable growth，To improve the level of the treatment of medical treatment insurance。”

　　据统计，去年，全省城镇职工的住院次均费用9586元，与上年的8845元相比上涨了741元，虽然药品取消了加成，实行零差率，但在医疗费用中占比重较大的检查费、仪器费、医用耗材费用等并没有被有效控制。

According to the statistics，Last year，The province town worker hospitalization time of all costs 9586 yuan，And the year 8845 yuan higher than 741 yuan，Although the drug cancelled addition，A zero rate，But in the medical cost accounting for a larger share of the inspection fee、Instrument fee、Medical consumables fees have not been effective control。

　　为深化医疗卫生体制改革，我省医疗保险付费方式也随之跟进，从今年起，我省全面推行总额控制下的预付制，结合门诊统筹实行居民医保按人头付费，结合住院大病保障推进县级以上医院实行按病种付费，简而言之，就是总额预付、按人头、按病种付费三种方式。其中，住院按病种付费是最让人关注的，而在几年前江苏部分地区已经开始推行单病种限价收费，这次《实施方案》的不同之处在于，这是首次在医保支付政策上，实行“按病种付费”。

To deepen the medical and health system reform，Our province medical insurance payment has to follow up，From this year，The full implementation of the province under the control of the total advance system，Combined with clinic to plan as a whole the residents health care on a per head pay，Combined with a serious illness in hospital at or above the county level shall guarantee promote hospital practice press disease to pay，In short，Total advance is、According to the head、Press disease to pay three ways。the，Hospital press disease to pay is the most let people concern，And in a few years ago parts of jiangsu province has begun to implement single disease price charge，the《Implementation plan》The difference between，It is the first time in the medical insurance payment policy，implement“Press disease to pay”。

2,“不还价”的7种大病是如何选出来的？ 2,“Don't bargain”Seven kinds of serious illness is how to choose？

这些病发病率较高而诊疗技术相对成熟，费用容易考量 The higher incidence and disease diagnosis relative mature，Cost easy to consider

　　记者从《实施方案》中看到，此次首次纳入试点的7种疾病为：儿童白血病、儿童先天性心脏病、乳腺癌手术治疗、宫颈癌手术治疗、耐多药肺结核、重性精神疾病、终末期肾病。

Reporters from《Implementation plan》saw，The first pilot into seven kind of disease for：Childhood leukemia、Congenital heart disease in children、Breast cancer surgery、Cervical cancer surgery、Resistance to many medicine tuberculosis、Heavy sexual mental illness、End-stage renal disease。

　　而此前，国家发改委和卫生部明确了104个病种，那么，这7个病种是如何从104个病种选出来的，选择的标准是什么呢？

And after，The national development and reform commission and the ministry of health has been clear about the 104 diseases，so，This is how to seven disease from 104 selected diseases，Choose what is the standard？

　　昨日，省人社厅有关负责人在接受采访时表示，这7个病种属于临床诊疗路径明确、并发症与合并症少，诊疗技术比较成熟，效果可以控制，而且每个病种大概需要的花费相比之下容易考量。“特别是这些病发病率比较高，老百姓负担较重，社会上也比较关注的，综合之下选了这7种病先试点。”

yesterday，Provincial people club hall relevant person in charge in an interview said，The seven diseases belong to clinical diagnosis, clear path、Less complications and complications，Diagnosis and treatment technology more mature，Effect can control，And every disease to need more cost compared with easy considerations。“Especially the disease incidence of a disease is higher，Relatively heavy burden on ordinary people，Also of concern to the society，Under the comprehensive chose this 7 kinds of disease first pilot。”

3，医保付费方式有什么变化？ 3，Medical insurance payment have what change？

由“被动付钱”到“一口价”，患者入院起所有费用就提前定下来 by“Passive pay”to“price”，All the patients to the hospital costs come down surely in advance

　　记者从省人社厅了解到，目前医保患者看病是按项目付费，比如，医生开药要交一次钱，抽血交一次钱，透视交一次钱，或者打点滴时的针头都要先交钱，最后出院结算时，所有的费用分两部分，一部分是在政策报销范围内的，这部分由医保结算；超出政策范围内的则由个人自己承担。

Reporters from the province people club hall to know，At present the doctor is medical insurance patients according to project pay，For example，The doctor prescribe to deliver a money，Blood into a money，Perspective into a money，Or a bit with a needle is to want to make money，Finally the hospital when settle accounts，All the expenses is divided into two parts，Part of it is within the scope of the policy to submit an expense account，This part of the medical insurance settlement；Beyond policy within the scope of the individual own expenses。

　　按项目付费导致的另一个结果是，在不同医院，相同的病种要花费多少钱有时是不一样的，比如，同样治疗儿童白血病，有的医院要花费十几万元，有的医院可能要花费二三十万。

According to the project to pay another as a result，In different hospitals，The same disease how much money should be spent sometimes is not the same，For example，The same treatment of children with leukemia，Some hospitals will cost several hundred thousand yuan，Some hospitals might take 2.3 million。

　　而《实施方案》以后，这7种大病的付费方式将实行“统一价”，医保患者会提前知道自己要花多少钱，而不再是“被动付钱”。限价付费是怎么个付法呢？以支付儿童白血病为例，不用再抽血交一次费，透视交一次费等，而是将病人从进入医院起，全部检查、治疗、手术、麻醉、床位、护理、药品、医用材料等所有费用，提前定下来，13万，如果患者花费了15万，多出2万元的钱就由医院倒贴。

and《Implementation plan》later，The 7 kinds of serious illness ways of paying for it will be“Unified price”，Medical insurance patients will know in advance how much money，And is no longer“Passive pay”。Price paid is how a pay method？To pay for childhood leukemia as an example，No longer let blood pay a fee，Perspective pay a fee, etc，But will enter the hospital patient from within，Complete inspection、treatment、surgery、anesthesia、beds、nursing、drugs、Medical materials all expenses，Decided in advance，130000，If patients spent 150000，More than 20000 yuan of money DaoTie by the hospital。