摘要目的 探讨天津市多家三级医院开展医保单病种付费方式后,对医疗服务质量所产生的影响.方法 采用回顾性分析和满意度调查问卷相结合的方式,剔除不符合研究标准的病例后,共选取天津市5家三级医院2015年1月至2017年5月的膀胱癌病例1035例,其中政策实施前采用普通医保结算方式者522例,政策实施后进入单病种的病例513例;从两组中各选择300例患者,128名主管医生,向其发放满意度调查问卷.结果 采用单病种付费方式后住院天数缩短1.27天,人均住院医疗费发生额下降1237元,患者自付金额平均下降3890元,拒付金额平均下降11元,患者和医生的满意度均有不同程度的提升,差异均有统计学意义(均P<0.05).结论 单病种付费方式控费效果明显,对医疗服务质量有一定的积极影响.

abstractsObjective To analyze the impact of medical service quality after single-disease payment method was in place at a number of tertiary hospitals in Tianjin .Methods Retrospective analysis and satisfaction questionnaire were used to choose 1035 cases of bladder cancer from January 2015 to May 2017 , consisting of 522 cases settled in conventional medical insurance payment prior to the reform , and 513 cases settled in the single-disease payment.300 patients were selected from each type plus 128 doctors, for satisfaction questionnaire survey .Results The single-disease payment method , since in place , had cut back the average days of stay by 1.27 days, per-capita inpatient medical expenses by 1237 yuan, average out-of-pocket payment by 3890 yuan, and the non-payment amount by 11 yuan.Both patients and doctors were more satisfied than before to a different extent , with the difference statistically significant (P<0.05). Conclusions Single-disease payment method can control the cost obviously , thus conducive to the quality of medical services .