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美国医疗保险的创新支付模式:捆绑支付的实施效果与经验分析
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An analysis of the effects and experience of bundled payment——an innovative payment model in the medical insurance system of USA.
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    摘要:

    捆绑支付又称为疾病病程治疗支付模式,是以患者为对象,整合从诊断到术后恢复的若干连续的治疗步骤,把总体治疗费用支付给一个或多个医疗服务提供者。目前,美国采取三种主要的捆绑支付模型,为“证实式服务”支付、“普罗米修斯式”支付和“服务改进式”支付。系列的研究表明,捆绑支付能在保持甚至提高医疗服务质量的基础上,降低医疗服务的成本。捆绑支付在按病种付费的基础上增加了总额预算控制,引入了费用预付支付率计算方法和潜在可避免的并发症津贴奖励,这些基于证据的费用控制和基于奖励的激励机制都值得我国借鉴。

    Abstract:

    Bundled payment, also known as episode-based payment, is based on the patient, and integrated several sequential therapeutic procedures from diagnosis to post operation. The total cost will be paid to one or more providers when procedures finish. Three types of bundled payment, including Proven-Care, Prometheus and the BPCI initiative of Medicare, have been put into practice in the medical insurance system of USA. The evidences from practices showed that bundled payment reduced the cost, simultaneously, and kept or improved the quality. Bundled payment based on DRGs, added global budget and brought in the evidence informed case rate and PAC allowance. It is very worthy for us that the evidence-based cost control and allowance-based incentive mechanism are used.

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蔡红兵,汪梦碧,龚时薇.美国医疗保险的创新支付模式:捆绑支付的实施效果与经验分析[J].中国卫生经济,2017,(2):94-96.美国医疗保险的创新支付模式:捆绑支付的实施效果与经验分析[J]. CHINESE HEALTH ECONOMICS,2017,(2):94-96.

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