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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。

　　據醫保處工作人(ren)員(yuan)介紹，按(an)病種(zhong)付費(fei)是指(zhi)以病種(zhong)為核算單位進行定額付費(fei)的(de)基本醫療保險(xian)醫療費(fei)用結算方式。實行按(an)病種(zhong)付費(fei)的(de)病種(zhong)是臨床(chuang)路(lu)徑明確、并發癥和合并癥少、診療相對規范、質量(liang)可(ke)控且費(fei)用穩(wen)定的(de)疾病。

　　實行按(an)病(bing)種(zhong)(zhong)付(fu)費(fei)(fei)的(de)首批病(bing)種(zhong)(zhong)有腦梗死、老年性白內障等107個病(bing)種(zhong)(zhong)，凡主(zhu)診(zhen)斷、主(zhu)操作符合實施按(an)病(bing)種(zhong)(zhong)付(fu)費(fei)(fei)的(de)，均(jun)納入(ru)按(an)病(bing)種(zhong)(zhong)付(fu)費(fei)(fei)范(fan)圍。全市二級(ji)以上公立醫(yi)療(liao)機構(gou)(gou)全部納入(ru)實施按(an)病(bing)種(zhong)(zhong)付(fu)費(fei)(fei)定點醫(yi)療(liao)機構(gou)(gou)，按(an)病(bing)種(zhong)(zhong)付(fu)費(fei)(fei)的(de)限(xian)(xian)額(e)標(biao)(biao)準(zhun)(zhun)與(yu)確定的(de)最高(gao)收費(fei)(fei)標(biao)(biao)準(zhun)(zhun)相同。按(an)病(bing)種(zhong)(zhong)付(fu)費(fei)(fei)的(de)具體(ti)數額(e)由(you)該(gai)病(bing)種(zhong)(zhong)付(fu)費(fei)(fei)的(de)限(xian)(xian)額(e)標(biao)(biao)準(zhun)(zhun)與(yu)該(gai)病(bing)人的(de)報銷比例決定。鼓(gu)勵有條件(jian)的(de)一(yi)級(ji)醫(yi)療(liao)機構(gou)(gou)實行按(an)病(bing)種(zhong)(zhong)付(fu)費(fei)(fei)，其按(an)病(bing)種(zhong)(zhong)付(fu)費(fei)(fei)的(de)限(xian)(xian)額(e)標(biao)(biao)準(zhun)(zhun)為三級(ji)醫(yi)療(liao)機構(gou)(gou)限(xian)(xian)額(e)標(biao)(biao)準(zhun)(zhun)的(de)60%，病(bing)種(zhong)(zhong)范(fan)圍主(zhu)要是手(shou)術病(bing)種(zhong)(zhong)，其他病(bing)種(zhong)(zhong)待條件(jian)成熟(shu)后(hou)逐步納入(ru)。

　　醫療保(bao)險(xian)按(an)病種(zhong)(zhong)(zhong)付(fu)費(fei)遵照“病種(zhong)(zhong)(zhong)控制(zhi)、確(que)保(bao)質量、定額(e)(e)結(jie)(jie)算(suan)、結(jie)(jie)余(yu)留用(yong)、超支不補(bu)”的原則(ze)結(jie)(jie)算(suan)。按(an)病種(zhong)(zhong)(zhong)付(fu)費(fei)病種(zhong)(zhong)(zhong)的醫療費(fei)用(yong)總額(e)(e)分為統(tong)籌(chou)金支付(fu)額(e)(e)和參(can)保(bao)人(ren)員自付(fu)額(e)(e)兩(liang)部分。參(can)保(bao)人(ren)員自付(fu)部分由(you)患者在出院時結(jie)(jie)算(suan)，統(tong)籌(chou)金支付(fu)部分由(you)醫保(bao)經(jing)辦機構結(jie)(jie)算(suan)。

　　醫(yi)療保(bao)險(xian)按(an)(an)病(bing)種(zhong)(zhong)(zhong)付(fu)費(fei)(fei)辦法出(chu)(chu)臺后，萊蕪市(shi)各級醫(yi)保(bao)經(jing)辦機(ji)構(gou)高(gao)度重視(shi)，加強組織領導，建(jian)立(li)(li)工(gong)作(zuo)機(ji)制，發(fa)揮(hui)好(hao)按(an)(an)病(bing)種(zhong)(zhong)(zhong)收付(fu)費(fei)(fei)的(de)協調(diao)作(zuo)用，做(zuo)好(hao)政策宣傳培訓，建(jian)立(li)(li)按(an)(an)病(bing)種(zhong)(zhong)(zhong)付(fu)費(fei)(fei)公示制度，主動接受群眾監督，確保(bao)按(an)(an)病(bing)種(zhong)(zhong)(zhong)付(fu)費(fei)(fei)順利實(shi)施(shi)(shi)。各定(ding)點醫(yi)療機(ji)構(gou)及時(shi)做(zuo)好(hao)了(le)(le)系(xi)統調(diao)整，按(an)(an)照規定(ding)的(de)病(bing)種(zhong)(zhong)(zhong)編碼、手術編碼及付(fu)費(fei)(fei)限(xian)額標(biao)準調(diao)整完善收費(fei)(fei)系(xi)統，做(zuo)好(hao)與醫(yi)保(bao)經(jing)辦機(ji)構(gou)按(an)(an)病(bing)種(zhong)(zhong)(zhong)結算項目對應，確保(bao)按(an)(an)病(bing)種(zhong)(zhong)(zhong)付(fu)費(fei)(fei)準入與退出(chu)(chu)的(de)順暢銜(xian)接。同時(shi)，定(ding)點醫(yi)療機(ji)構(gou)建(jian)立(li)(li)了(le)(le)按(an)(an)病(bing)種(zhong)(zhong)(zhong)收費(fei)(fei)知情告知書，在(zai)保(bao)證患者(zhe)的(de)知情權、選(xuan)擇(ze)權的(de)同時(shi)，做(zuo)好(hao)政策解(jie)釋，讓患者(zhe)了(le)(le)解(jie)按(an)(an)病(bing)種(zhong)(zhong)(zhong)付(fu)費(fei)(fei)的(de)優勢，為推進按(an)(an)病(bing)種(zhong)(zhong)(zhong)付(fu)費(fei)(fei)實(shi)施(shi)(shi)創造良好(hao)環境。