| 引用本文：赵斌, 陈曼莉.美国Medicare和Medicaid对长期护理服务的付费方式及对我国的启示[J].中国卫生政策研究,2018,11(8):22-28 |
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| 美国Medicare和Medicaid对长期护理服务的付费方式及对我国的启示 |
| 投稿时间：2018-02-12 修订日期：2018-05-03 PDF全文浏览 HTML全文浏览 |
| 赵斌1, 陈曼莉2 |
1. 中国劳动和社会保障科学研究院医疗保险和护理保险研究室 北京 100029;
2. 湖北中医药大学管理学院 湖北武汉 430065 |
| 摘要:我国早期长期护理保险的自发探索中，各地普遍对长期护理服务采取按床日付费方式。这一相对简易的方式，无法有效体现各个病例服务消耗的资源，也导致部分地区和机构由于患者少难以开展相应业务或"患者挑选"的收治行为异化的情况。而从美国经验看，付费方式可进一步精细和科学化。因此，本研究借鉴美国医疗照顾和医疗援助制度相关付费方式经验，结合我国实践，提出应尽力实现护理服务个案的资源消耗与付费标准之间的匹配，建立费用结算额与护理服务效果之间的关联。 |
| 关键词:长期护理服务 付费方式 美国 |
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| The study on payment methods of US medicare and medicaid for long-term medical care services and their implications for China |
| ZHAO Bin1, CHEN Man-li2 |
1. Research Office of Health Insurance and Long Term Care Insurance, Chinese Academy of Labor and Social Security, Beijing 100029, China;
2. Management College, Hubei University of Chinese Medicine, Wuhan Hubei 430065, China |
| Abstract:In the spontaneous exploration of early long-term medical insurance in China, the daily bed payment for long-term medical care services is widely adopted. This payment is relatively simple as a method, and cannot effectively reflects the resources consumed by each service rendered, but also leads to the situation in which it is very difficult for some regions and institutions to carry out the corresponding business due to a small number of patients coming to them. From the experience of other countries such as the United States, the payment methods can be further refined and even more scientific. Therefore, this study draws lessons from the of US medicare and medicaid system's related payment methods combined with China's practice and explores the perfect specific ideas. This paper proposes that efforts should be made in order to achieve a good match between the resource utilization and payment standards of long-term medical care service cases. The combination of case grouping and performance based payment should be gradually approached, and a relationship between the cost settlement amount and effective long-term medical care services should be established respectively. |
| Key words:Long-term care service Payment methods The United States |
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