湖南省长沙市借鉴国际经验,对住院康复护理支付方式改革进行探索。根据康复需求强度,将康复治疗划分为恢复期与慢性期,分别建立“功能相关分组（FRG）”和“基于患者需求的慢性康复分组（PDCRG）”,并进行配套评估量表的开发和按康复疗效进行激励的制度设计,初步建立起康复病组按价值付费的制度框架。未来将通过模拟运行精准测算支付标准,进一步完善功能评估量表,细化康复疗效价值评估与激励办法,完善康复病组按价值付费体系,从而促进康复护理服务规范发展,降低患者医疗费用负担,提升医保资金使用效率,最终实现“医、患、保”三方共赢的目标。

Drawing on international experiences, Changsha City of Hunan Province explored reform of its payment method for inpatient rehabilitation. Based on the intensity of therapies, rehabilitation is divided into “recovery phase” and “chronic phase”, for which Function-Related Groups (FRG) and Patient-Driven Chronic Rehabilitation Groups (PDCRG) were established as case-mix groups. Functional assessment scales and value-based incentive mechanism were developed. In the future, data would be collected in the simulation phase to refine case-mix groups and payment standards, improve the functional assessment tools, and establish reasonable value assessment method, in order to optimize the value-based payment system to achieve the goal of triple-win between patients, providers and insurers.