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9月18日，記者從萊蕪市人社局醫保處了解到，為貫徹國家和省深化醫藥衛生體制改革精神，完善萊蕪市基本醫療保險付費方式，結合萊蕪市醫療保險實際，萊蕪市出臺了醫療保險按病種付費辦法，此次萊蕪市共有107個病種醫療保險實施按病種付費。

　　據醫(yi)保處工作人員介紹，按病(bing)種付費(fei)(fei)是指以病(bing)種為核算單位進行(xing)(xing)定額付費(fei)(fei)的(de)基本(ben)醫(yi)療保險醫(yi)療費(fei)(fei)用結算方式。實行(xing)(xing)按病(bing)種付費(fei)(fei)的(de)病(bing)種是臨床路徑明(ming)確(que)、并發(fa)癥和合(he)并癥少、診療相對規范、質量(liang)可控且(qie)費(fei)(fei)用穩定的(de)疾(ji)病(bing)。

　　實(shi)(shi)行按(an)(an)(an)病(bing)(bing)(bing)種(zhong)(zhong)(zhong)付(fu)費(fei)(fei)的(de)(de)首批病(bing)(bing)(bing)種(zhong)(zhong)(zhong)有(you)腦梗死(si)、老年性(xing)白內障等107個病(bing)(bing)(bing)種(zhong)(zhong)(zhong)，凡主(zhu)診斷、主(zhu)操作符合實(shi)(shi)施(shi)按(an)(an)(an)病(bing)(bing)(bing)種(zhong)(zhong)(zhong)付(fu)費(fei)(fei)的(de)(de)，均納入(ru)按(an)(an)(an)病(bing)(bing)(bing)種(zhong)(zhong)(zhong)付(fu)費(fei)(fei)范(fan)圍(wei)。全(quan)市二(er)級(ji)以上公立醫(yi)療機構(gou)全(quan)部納入(ru)實(shi)(shi)施(shi)按(an)(an)(an)病(bing)(bing)(bing)種(zhong)(zhong)(zhong)付(fu)費(fei)(fei)定點醫(yi)療機構(gou)，按(an)(an)(an)病(bing)(bing)(bing)種(zhong)(zhong)(zhong)付(fu)費(fei)(fei)的(de)(de)限(xian)額(e)標(biao)準(zhun)(zhun)與確定的(de)(de)最高收費(fei)(fei)標(biao)準(zhun)(zhun)相同。按(an)(an)(an)病(bing)(bing)(bing)種(zhong)(zhong)(zhong)付(fu)費(fei)(fei)的(de)(de)具體數額(e)由該病(bing)(bing)(bing)種(zhong)(zhong)(zhong)付(fu)費(fei)(fei)的(de)(de)限(xian)額(e)標(biao)準(zhun)(zhun)與該病(bing)(bing)(bing)人的(de)(de)報銷(xiao)比例決定。鼓(gu)勵有(you)條件(jian)的(de)(de)一級(ji)醫(yi)療機構(gou)實(shi)(shi)行按(an)(an)(an)病(bing)(bing)(bing)種(zhong)(zhong)(zhong)付(fu)費(fei)(fei)，其(qi)按(an)(an)(an)病(bing)(bing)(bing)種(zhong)(zhong)(zhong)付(fu)費(fei)(fei)的(de)(de)限(xian)額(e)標(biao)準(zhun)(zhun)為三(san)級(ji)醫(yi)療機構(gou)限(xian)額(e)標(biao)準(zhun)(zhun)的(de)(de)60%，病(bing)(bing)(bing)種(zhong)(zhong)(zhong)范(fan)圍(wei)主(zhu)要是手術病(bing)(bing)(bing)種(zhong)(zhong)(zhong)，其(qi)他病(bing)(bing)(bing)種(zhong)(zhong)(zhong)待條件(jian)成(cheng)熟后(hou)逐步納入(ru)。

　　醫(yi)療保險按病(bing)種(zhong)(zhong)付(fu)費(fei)遵照“病(bing)種(zhong)(zhong)控制、確保質量、定額(e)結(jie)算、結(jie)余留用(yong)、超(chao)支不補”的原則結(jie)算。按病(bing)種(zhong)(zhong)付(fu)費(fei)病(bing)種(zhong)(zhong)的醫(yi)療費(fei)用(yong)總(zong)額(e)分為統籌金支付(fu)額(e)和參(can)保人員(yuan)自(zi)(zi)付(fu)額(e)兩部(bu)(bu)分。參(can)保人員(yuan)自(zi)(zi)付(fu)部(bu)(bu)分由(you)患(huan)者在出院時(shi)結(jie)算，統籌金支付(fu)部(bu)(bu)分由(you)醫(yi)保經辦機構結(jie)算。

　　醫(yi)療(liao)(liao)(liao)保(bao)(bao)險按(an)(an)(an)病(bing)(bing)種(zhong)付(fu)費(fei)(fei)(fei)辦(ban)法出(chu)(chu)臺后，萊(lai)蕪(wu)市各(ge)(ge)級醫(yi)保(bao)(bao)經辦(ban)機(ji)(ji)構(gou)(gou)高度重(zhong)視，加強組織領導，建(jian)立工作機(ji)(ji)制，發揮好(hao)(hao)按(an)(an)(an)病(bing)(bing)種(zhong)收(shou)付(fu)費(fei)(fei)(fei)的協調(diao)(diao)(diao)作用(yong)，做好(hao)(hao)政策宣傳培訓(xun)，建(jian)立按(an)(an)(an)病(bing)(bing)種(zhong)付(fu)費(fei)(fei)(fei)公示制度，主動接(jie)(jie)受群眾監督，確保(bao)(bao)按(an)(an)(an)病(bing)(bing)種(zhong)付(fu)費(fei)(fei)(fei)順利實(shi)施(shi)。各(ge)(ge)定(ding)點醫(yi)療(liao)(liao)(liao)機(ji)(ji)構(gou)(gou)及(ji)時(shi)(shi)做好(hao)(hao)了(le)系統(tong)調(diao)(diao)(diao)整，按(an)(an)(an)照規(gui)定(ding)的病(bing)(bing)種(zhong)編碼(ma)、手術編碼(ma)及(ji)付(fu)費(fei)(fei)(fei)限額標準調(diao)(diao)(diao)整完善(shan)收(shou)費(fei)(fei)(fei)系統(tong)，做好(hao)(hao)與(yu)醫(yi)保(bao)(bao)經辦(ban)機(ji)(ji)構(gou)(gou)按(an)(an)(an)病(bing)(bing)種(zhong)結(jie)算項目對應，確保(bao)(bao)按(an)(an)(an)病(bing)(bing)種(zhong)付(fu)費(fei)(fei)(fei)準入與(yu)退出(chu)(chu)的順暢(chang)銜接(jie)(jie)。同(tong)時(shi)(shi)，定(ding)點醫(yi)療(liao)(liao)(liao)機(ji)(ji)構(gou)(gou)建(jian)立了(le)按(an)(an)(an)病(bing)(bing)種(zhong)收(shou)費(fei)(fei)(fei)知情告(gao)知書(shu)，在保(bao)(bao)證患(huan)者(zhe)的知情權(quan)、選擇權(quan)的同(tong)時(shi)(shi)，做好(hao)(hao)政策解釋(shi)，讓患(huan)者(zhe)了(le)解按(an)(an)(an)病(bing)(bing)種(zhong)付(fu)費(fei)(fei)(fei)的優(you)勢，為(wei)推進按(an)(an)(an)病(bing)(bing)種(zhong)付(fu)費(fei)(fei)(fei)實(shi)施(shi)創造良好(hao)(hao)環境。