目的：医疗服务价格体系的构建涉及医保部门、医疗机构、患者等多方利益主体,有序推进医疗服务价格改革,对于深化医药卫生体制改革、推进我国医疗保障事业高质量发展具有重要意义。方法：本文基于PDCA循环理论,系统分析云南省玉溪市作为省级试点城市的改革实践路径。结果：研究表明,玉溪市通过计划（Plan）阶段的制度设计与构建、执行（Do）阶段的政策落地与资源投入、检查（Check）阶段的成效监测与问题识别、处理（Act）阶段的反馈优化与持续改进,初步形成改革闭环管理机制,优化了医院收入结构、保障了参保人员待遇稳定和医保基金支出的可持续性。但在玉溪市医疗服务价格改革的过程中,也存在医疗服务价格信息化管理相对落后、医疗服务价格调整制度设计有待完善、医疗服务价格调整与医疗机构需求存在差距、专业人员不足等问题。结论：建议在加快建设医疗服务价格综合管理信息平台、切实组织好医疗服务价格动态调整和跟踪监测、重视医疗服务项目成本核算、加快专业队伍建设四方面采取相应措施,系统推进医疗保障事业高质量发展。
Abstract
Objective: The construction of a medical service price system involves multiple stakeholders such as healthcare security administrations, medical institutions, and patients. The orderly promotion of medical service price reform is of great significance for deepening the reform of the medical system and promoting the high-quality development of China's healthcare security industry. Method: Based on the PDCA cycle theory, this article systematically analyzes the reform practice path of Yuxi City in Yunnan Province as a provincial-level pilot city. Result: Research has shown that Yuxi City has initially formed a closed-loop management mechanism through institutional design and construction in the Plan stage, policy implementation and resource investment in the Do stage, effectiveness monitoring and problem identification in the Check stage, and feedback optimization and continuous improvement in the Act stage. The reform has optimized the hospital's income structure, ensured stable benefits for insured persons, and ensured the sustainability of medical insurance fund expenditures. However, in the process of medical service price reform in Yuxi City, there are also problems such as relatively outdated information management of medical service prices, incomplete design of medical service price adjustment system, gap between medical service price adjustment and medical institution demand, and shortage of professional personnel. Conclusion: It is recommended to take corresponding measures in four aspects: accelerating the construction of a comprehensive management information platform for medical service prices, effectively organizing dynamic adjustments tracking and monitoring of medical service prices, attaching importance to cost accounting of medical service items, and accelerating the construction of professional teams, in order to systematically promote the high-quality development of healthcare security.
关键词
PDCA循环 /
医疗服务价格改革 /
动态调整 /
政策优化
Key words
PDCA cycle /
medical service prices reform /
dynamic adjustment /
healthcare security /
policy optimization
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基金
国家自然科学基金项目“标尺竞争机制、DRG/DIP支付方式改革与医疗服务定价”（72204251）; 玉溪市医疗保障局委托项目“玉溪市医疗服务价格改革”（2023K20133）
