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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)員介紹，按(an)病(bing)(bing)種(zhong)(zhong)付(fu)費(fei)是(shi)指以病(bing)(bing)種(zhong)(zhong)為核算單(dan)位進(jin)行定(ding)額(e)付(fu)費(fei)的基本醫療保險醫療費(fei)用結(jie)算方式(shi)。實行按(an)病(bing)(bing)種(zhong)(zhong)付(fu)費(fei)的病(bing)(bing)種(zhong)(zhong)是(shi)臨床路徑明(ming)確、并(bing)發癥(zheng)和(he)合并(bing)癥(zheng)少(shao)、診療相對規(gui)范(fan)、質量(liang)可控且費(fei)用穩定(ding)的疾病(bing)(bing)。

　　實行(xing)按(an)(an)(an)病(bing)(bing)(bing)種(zhong)(zhong)付(fu)(fu)(fu)費(fei)(fei)的(de)(de)(de)首批(pi)病(bing)(bing)(bing)種(zhong)(zhong)有腦梗死、老年性白內(nei)障等107個(ge)病(bing)(bing)(bing)種(zhong)(zhong)，凡(fan)主(zhu)(zhu)診斷、主(zhu)(zhu)操作(zuo)符合實施按(an)(an)(an)病(bing)(bing)(bing)種(zhong)(zhong)付(fu)(fu)(fu)費(fei)(fei)的(de)(de)(de)，均納入按(an)(an)(an)病(bing)(bing)(bing)種(zhong)(zhong)付(fu)(fu)(fu)費(fei)(fei)范圍。全市二級以上公立(li)醫療(liao)機構(gou)全部納入實施按(an)(an)(an)病(bing)(bing)(bing)種(zhong)(zhong)付(fu)(fu)(fu)費(fei)(fei)定點醫療(liao)機構(gou)，按(an)(an)(an)病(bing)(bing)(bing)種(zhong)(zhong)付(fu)(fu)(fu)費(fei)(fei)的(de)(de)(de)限(xian)額(e)(e)標(biao)(biao)準(zhun)與確定的(de)(de)(de)最(zui)高收費(fei)(fei)標(biao)(biao)準(zhun)相同。按(an)(an)(an)病(bing)(bing)(bing)種(zhong)(zhong)付(fu)(fu)(fu)費(fei)(fei)的(de)(de)(de)具體數額(e)(e)由該(gai)病(bing)(bing)(bing)種(zhong)(zhong)付(fu)(fu)(fu)費(fei)(fei)的(de)(de)(de)限(xian)額(e)(e)標(biao)(biao)準(zhun)與該(gai)病(bing)(bing)(bing)人(ren)的(de)(de)(de)報銷比例(li)決定。鼓勵有條(tiao)件(jian)(jian)的(de)(de)(de)一級醫療(liao)機構(gou)實行(xing)按(an)(an)(an)病(bing)(bing)(bing)種(zhong)(zhong)付(fu)(fu)(fu)費(fei)(fei)，其(qi)按(an)(an)(an)病(bing)(bing)(bing)種(zhong)(zhong)付(fu)(fu)(fu)費(fei)(fei)的(de)(de)(de)限(xian)額(e)(e)標(biao)(biao)準(zhun)為三級醫療(liao)機構(gou)限(xian)額(e)(e)標(biao)(biao)準(zhun)的(de)(de)(de)60%，病(bing)(bing)(bing)種(zhong)(zhong)范圍主(zhu)(zhu)要是(shi)手(shou)術病(bing)(bing)(bing)種(zhong)(zhong)，其(qi)他病(bing)(bing)(bing)種(zhong)(zhong)待條(tiao)件(jian)(jian)成熟后逐步納入。

　　醫療保(bao)險(xian)按(an)病(bing)(bing)種(zhong)(zhong)付(fu)(fu)(fu)費(fei)遵照“病(bing)(bing)種(zhong)(zhong)控制、確(que)保(bao)質(zhi)量、定額結算、結余留(liu)用(yong)、超支不補”的(de)原則結算。按(an)病(bing)(bing)種(zhong)(zhong)付(fu)(fu)(fu)費(fei)病(bing)(bing)種(zhong)(zhong)的(de)醫療費(fei)用(yong)總(zong)額分為統籌(chou)金支付(fu)(fu)(fu)額和參保(bao)人員自付(fu)(fu)(fu)額兩部分。參保(bao)人員自付(fu)(fu)(fu)部分由(you)患者在出(chu)院(yuan)時(shi)結算，統籌(chou)金支付(fu)(fu)(fu)部分由(you)醫保(bao)經(jing)辦機構結算。

　　醫(yi)療(liao)保險按(an)(an)病種(zhong)(zhong)付(fu)費(fei)辦法出臺后，萊蕪市各級(ji)醫(yi)保經辦機(ji)(ji)構(gou)(gou)高度(du)重(zhong)視，加強組織領(ling)導，建立工作機(ji)(ji)制，發揮好按(an)(an)病種(zhong)(zhong)收付(fu)費(fei)的(de)協(xie)調作用，做好政(zheng)(zheng)策宣傳(chuan)培(pei)訓，建立按(an)(an)病種(zhong)(zhong)付(fu)費(fei)公示制度(du)，主動接受(shou)群眾監(jian)督，確保按(an)(an)病種(zhong)(zhong)付(fu)費(fei)順利實(shi)施。各定(ding)點醫(yi)療(liao)機(ji)(ji)構(gou)(gou)及時做好了(le)系統(tong)調整，按(an)(an)照規定(ding)的(de)病種(zhong)(zhong)編(bian)碼、手術編(bian)碼及付(fu)費(fei)限額標準(zhun)調整完(wan)善(shan)收費(fei)系統(tong)，做好與醫(yi)保經辦機(ji)(ji)構(gou)(gou)按(an)(an)病種(zhong)(zhong)結算項(xiang)目對(dui)應，確保按(an)(an)病種(zhong)(zhong)付(fu)費(fei)準(zhun)入與退出的(de)順暢銜接。同(tong)時，定(ding)點醫(yi)療(liao)機(ji)(ji)構(gou)(gou)建立了(le)按(an)(an)病種(zhong)(zhong)收費(fei)知(zhi)情(qing)告(gao)知(zhi)書，在保證患(huan)者(zhe)的(de)知(zhi)情(qing)權、選(xuan)擇權的(de)同(tong)時，做好政(zheng)(zheng)策解釋，讓(rang)患(huan)者(zhe)了(le)解按(an)(an)病種(zhong)(zhong)付(fu)費(fei)的(de)優(you)勢，為推進按(an)(an)病種(zhong)(zhong)付(fu)費(fei)實(shi)施創(chuang)造良(liang)好環境(jing)。