| 引用本文：杜天天, 刘跃华, 杨燕绥.美国专业护理机构以患者为导向的病例分组支付方式研究——从RUG到PDPM[J].中国卫生政策研究,2020,13(6):73-80 |
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| 美国专业护理机构以患者为导向的病例分组支付方式研究——从RUG到PDPM |
| 投稿时间：2020-03-02 修订日期：2020-04-29 PDF全文浏览 HTML全文浏览 |
| 杜天天1, 刘跃华2,3, 杨燕绥1 |
1. 清华大学医院管理研究院 广东深圳 518055;
2. 国家卫生健康委卫生发展研究中心 北京 100191;
3. 国家卫生健康委国家药物和卫生技术综合评估中心 北京 100191 |
| 摘要:人口老龄化和疾病谱变化带来的长期护理问题已成为世界关注的焦点，我国也在积极探索长期护理的筹资制度。美国于2019年开始了新一轮长期护理保险支付方式改革。本文梳理和回顾了其支付方式发展历程，并对老年医疗保险对专业护理机构最新的支付方式改革进行详细介绍。该支付方式在价值驱动下，以真实成本为基础，根据患者特征和需求将患者划分为不同病例组，并以此分组为依据进行支付，消除“按数量”的付费特征、提高支付的精确性。上述改革可以为我国长期护理保险支付方式进一步精细和科学化提出有益借鉴。 |
| 关键词:长期护理保险 支付方式 按病例分组支付 美国 |
| 基金项目:国家社科基金（17ZDA121）；国家自然科学基金（71804032） |
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| Study on the patient driven case-mix payment method in American skilled nursing facilities: From RUG to PDPM |
| DU Tian-tian1, LIU Yue-hua2,3, YANG Yan-sui1 |
1. Insitute for hospital management, Tsinghua University, Shenzhen Guangdong 518055, China;
2. China National Health Development Research Center, Beijing 100191, China;
3. National Center for Drug and Technology Assessment, Beijing 100191, China |
| Abstract:The problem of long-term care brought about by the aging population and changes in the disease spectrum has become the focus of attention in the world, and China is also actively exploring the financing system for long-term care. In 2019, the United States started a new round of reforms in the long-term care insurance payment method. Pertaining to that, this paper screens and reviews the history of long-term care insurance and its payment methods, and provides a detailed introduction to the latest payment methods reform for senior medical insurance companies' professional nursing facilities. This payment method is driven by value and based on real costs, patients are divided into different case groups according to the characteristics and needs of patients, and payment is made based on this grouping, eliminating the "by quantity" payment feature and improving the payment accuracy. The above-mentioned reforms can provide useful reference for the further elaboration and scientificization of payment methods used for long-term care insurance in China. |
| Key words:Long-term care insurance Payment method Case-mix United States |
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