medical insurance,Single Disease Payment,Quality Management,Cost Control
目的：探讨基本医疗保险制度下的单病种医疗质量和医疗费用控制办法。方法：介绍某三甲医院实施单病种付费管理工作的具体实践及五大举措，回顾性分析2017-2019年常见的6个医保单病种出院人次、人均费用及人均住院天数。结果：医保单病种医疗质量明显提高，医疗费用得到了有效的控制和降低。结论：医院创新单病种付费管理，可以提高医疗质量和基金效率。为弥补单病种付费方式的缺陷，可探索引入按诊断相关分组-预付款制度（DRGs-PPS），将对医院的医保管理提出新的挑战。
Objective：To explore the control methods of single disease medical quality and medical expenses under the basic medical insurance system. Methods：Introduce the specific practice and five major measures for implementing a single disease payment management in a certain Grade-A Tertiary Hospital，and retrospectively analyze the number of hospital discharges，per capita expenses，and the number of hospitalization days per capita for six single disease included in medical insurance from 2017 to 2019. Result：The medical quality of single diseases has been significantly improved，and medical expenses have been effectively controlled and reduced. Conclusion：Innovative single disease payment management in hospitals can improve medical quality and fund efficiency. Considering the shortages of single disease payment，it is highly recommended to explore the introduction of DRGs-PPS（Diagnostic Related Groups-prospective payment system），which puts forward new challenges for medical insurance management of hospitals.