medical insurance end-stage renal disease case payment implementation
目的：分析南通市近四年终末期肾病单病种付费实施现状及存在相关问题，为单病种付费制度的改革与完善提供参考依据与建议。方法：利用回顾性分析方法对两家三甲医院2015—2018年终末期肾病签约患者费用发生情况及诊疗中存在的问题进行归纳研究。结果：腹膜透析结算定额偏高，血液透析结算定额需待调整；定额结算难以满足患者差异化医疗服务需求。结论：单病种付费的长远发展，是在医保基金节约使用的前提下，既要保证患者得到合理有效的治疗，又要兼顾医院合理收益，才能确保医疗事业的发展。
Objective： To analyze the implementation and related problems of end-stage renal disease case payment in the last four years in Nantong，and to provide evidence-based suggestions for appropriate medical insurance payment policies. Methods：The payment situation and problems in the treatment in the contract patient during 2015 to 2018 in the two grade-A tertiary Hospital=s. Results：The quota of peritoneum dialysis was high and the hemodialysis need to be adjusted；The quota settlement could not meet the differentiated medical service needs. Conclusions：The long-term development of end-stage renal disease is based on the reasonable use of medical insurance fund，which should ensure effective treatment for patients and the reasonable interests for hospital.