| 引用本文：刘星辰, 杨燕绥, 李超凡.美国门诊病例分组预付制的经验及对我国的启示[J].中国卫生政策研究,2021,14(7):48-54 |
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| 美国门诊病例分组预付制的经验及对我国的启示 |
| 投稿时间：2021-05-13 修订日期：2021-06-25 PDF全文浏览 HTML全文浏览 |
| 刘星辰1, 杨燕绥1, 李超凡2,3 |
1. 清华大学医院管理研究院 广东深圳 518055;
2. 山东大学齐鲁医学院公共卫生学院卫生管理与政策研究中心 山东济南 250012;
3. 国家卫生健康委员会卫生经济与政策研究重点实验室(山东大学) 山东济南 250012 |
| 摘要:目的：梳理美国门诊病例分组（Ambulatory Patient Groups，APG）政策发展历程，为完善我国门诊支付方式提供经验借鉴。方法：基于文献分析法，系统总结美国开展APG支付的具体措施、实施范围和效果。结果：过去30年门诊病例分组发展了四个版本，分组结果逐步精细化、科学化，从最初的299组增长到606组。18个州的Medicaid和13个第三方付费机构应用APG的经验表明，虽然APG可以有效控制门诊医疗费用增长，但推广实施也存在病历编码和信息系统要求高、专业人才缺乏、分组结果需要更新等难点。结论：APG门诊预付制可以有效控制医疗费用不合理增长，未来我国需要规范门诊电子病历编码，建立APG分组方法体系，在总额预算基础上建立门诊服务预付制，逐步健全门诊支付机制。 |
| 关键词:门诊病例分组 预付制 门诊服务 |
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| The experience of Ambulatory Patient Group prospective payment system in the United States and its implications for China |
| LIU Xing-chen1, YANG Yan-sui1, LI Chao-fan2,3 |
1. Institute for Hospital Management, Tsinghua University, Shenzhen Quangdong 518055, China;
2. Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan Shandong 250012, China;
3. NHC Key Lab of Health Economics and Policy Research(Shandong University), Jinan Shandong 250012, China |
| Abstract:Objective: The purpose of this study is to study the policies of Ambulatory Patient Group (APG), and provide experience for China to strengthen the outpatient payment system. Methods: Based on scoping review, we systematically summarized the APG specific grouping measures, payment progress, implementation scope and effects. Results: During the past 30 years, researches had developed four versions of APG scheme. The grouping scheme gradually become more and more elaborate and scientific. The number of groups increased from 299 to 606 groups. Experience of 18 Medicaid programs and 13 commercial payers illustrates that although APG payment method could effectively control the growth of outpatient medical expenses, it still has several barriers to implement:1) outpatient electronic medical records and information system is incomplete; 2) lack of professional coders; 3) grouping system should be periodically updated with pace of medical technology development. Conclusions: APG outpatient prospective payment system can effectively control the unreasonable growth of medical expenses. In order to build the outpatient prospective payment system, China needs to standardize the outpatient electronic medical record coding, establish APG grouping methodology, establish outpatient service prospective payment system on the basis of global budget in future. |
| Key words:Ambulatory Patient Groups Prospective payment system Outpatient health services |
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