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目的探索成都地区终末期肾病门诊透析治疗的定额支付评价指标及其合理额度,为单病种付费提供科学依据。方法采用问卷调查法收集患者的费用信息,根据治疗原则及统计结果制定赋值评价指标;采用德菲尔法确定赋值分值及定额支付标准。结果本调查涉及17家成都市医疗保险特约透析机构,共发出调查表700份,收回调查表686份,排除项目填写漏项、患者治疗信息不准确的调查表26份后,实际纳入分析的调查表共660份,占调查总人数的94.28%。调查结果显示:血液透析治疗率占调查人群的84%(555/660),腹膜透析治疗率占调查人群的16%(105/660)。通过评估项目赋值后获得的血液透析门诊最低年支付额118 242.75元,腹膜透析门诊最低年支付额96 498.00元。结论通过治疗项目赋值后的门诊透析定额支付证据性强,门诊透析治疗的分级定额支付可使医疗保险基金得到更合理的应用。
Objective To explore the quota evaluation index and reasonable quota for outpatient dialysis treatment of end stage renal disease in Chengdu and to provide a scientific basis for the payment of single disease. Methods The questionnaire method was used to collect the patient’s cost information, and the evaluation index was established according to the treatment principle and the statistical result. The valuation value and the fixed payment standard were determined by the Defell method. Results The survey involved 17 medical insurance dialysis agencies in Chengdu. A total of 700 questionnaires were sent out and 686 questionnaires were withdrawn. After the 26 items of questionnaires with missing items and inaccurate patient treatment information were excluded, the survey was actually included in the analysis A total of 660 copies, accounting for 94.28% of the total number of people surveyed. The results of the survey showed that hemodialysis treatment accounted for 84% (555/660) of the surveyed population and peritoneal dialysis treatment accounted for 16% (105/660) of the surveyed population. The minimum annual payment for hemodialysis clinics obtained after evaluation of the project assignment was 118 242.75 yuan and the minimum yearly payment for peritoneal dialysis clinic was 96 498.00 yuan. Conclusion Evidence-based payment of outpatient dialysis after the assignment of treatment items is strong, and the graded fixed payment for outpatient dialysis treatment can make the medical insurance fund more reasonable.