目的: 评估尿毒症门诊血液透析单病种全费用包干结算模式的实践效果,为深化医保支付方式改革、控制医疗费用不合理增长、保障透析患者医疗质量提供实证依据。方法: 基于云南省楚雄州2015—2024年实施尿毒症门诊血液透析全费用包干结算模式改革前后的数据,分析医疗费用、医保基金支出、医疗机构服务行为的变化。结果: 实施尿毒症门诊血液透析全费用包干模式后,门诊血液透析患者月均医疗费用、年度医保基金支出增长率明显放缓,月均个人自付费用显著降低;医疗机构医疗质量得以保障,服务质效稳步提升。结论: 尿毒症门诊血液透析全费用包干结算模式能有效控制门诊血液透析医疗成本,引导医疗机构主动规范诊疗行为,实现了“控成本”与“保质量”的平衡,具有重要的推广价值。

Objective: The paper evaluates the practical effect of the single-disease global budget payment model for outpatient hemodialysis in uremia, to provide empirical evidence for deepening the reform of medical insurance payment methods, controlling the unreasonable growth of medical expenses, and ensuring the medical quality of dialysis patients. Methods: Based on pre- and post-implementation data of the global budget payment model for outpatient hemodialysis in Chuxiong Yi Autonomous Prefecture, Yunnan Province from 2015 to 2024, we analyzed changes in medical expenses, medical insurance fund expenditure and medical institution service behaviors. Results: Following the implementation of the global budget payment model for outpatient hemodialysis, the average monthly medical expenses of outpatient hemodialysis patients and the growth rate of annual medical insurance fund expenditure slowed down significantly, while the average monthly out-of-pocket expenses of patients decreased remarkably. Meanwhile, the medical quality of medical institutions was guaranteed, and the service quality and efficiency were improved steadily. Conclusion: The global budget payment model for outpatient hemodialysis in uremia can effectively manage the medical expenses, guide medical institutions to proactively standardize their clinical practices, achieve a balance between "managing expenses" and "ensuring quality", with significant promotion value.