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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(ju)醫(yi)保處工作人員介紹，按病(bing)種付費(fei)是指以病(bing)種為(wei)核算(suan)單位進行定額(e)付費(fei)的(de)(de)基(ji)本醫(yi)療(liao)保險醫(yi)療(liao)費(fei)用結算(suan)方式。實行按病(bing)種付費(fei)的(de)(de)病(bing)種是臨床(chuang)路徑(jing)明(ming)確、并(bing)(bing)發癥和合并(bing)(bing)癥少、診療(liao)相對規范、質量(liang)可控且費(fei)用穩定的(de)(de)疾病(bing)。

　　實行(xing)(xing)按(an)(an)(an)病(bing)(bing)種(zhong)(zhong)付(fu)(fu)(fu)費(fei)(fei)(fei)(fei)的首(shou)批病(bing)(bing)種(zhong)(zhong)有(you)腦梗死、老年性(xing)白內障等107個病(bing)(bing)種(zhong)(zhong)，凡主(zhu)診斷、主(zhu)操(cao)作符合實施(shi)(shi)按(an)(an)(an)病(bing)(bing)種(zhong)(zhong)付(fu)(fu)(fu)費(fei)(fei)(fei)(fei)的，均(jun)納入(ru)按(an)(an)(an)病(bing)(bing)種(zhong)(zhong)付(fu)(fu)(fu)費(fei)(fei)(fei)(fei)范圍(wei)(wei)。全市二級以上(shang)公立醫(yi)(yi)療機構全部納入(ru)實施(shi)(shi)按(an)(an)(an)病(bing)(bing)種(zhong)(zhong)付(fu)(fu)(fu)費(fei)(fei)(fei)(fei)定點醫(yi)(yi)療機構，按(an)(an)(an)病(bing)(bing)種(zhong)(zhong)付(fu)(fu)(fu)費(fei)(fei)(fei)(fei)的限(xian)額標準與(yu)確定的最高收費(fei)(fei)(fei)(fei)標準相同(tong)。按(an)(an)(an)病(bing)(bing)種(zhong)(zhong)付(fu)(fu)(fu)費(fei)(fei)(fei)(fei)的具體(ti)數額由該病(bing)(bing)種(zhong)(zhong)付(fu)(fu)(fu)費(fei)(fei)(fei)(fei)的限(xian)額標準與(yu)該病(bing)(bing)人(ren)的報銷比(bi)例決定。鼓勵有(you)條(tiao)件(jian)的一級醫(yi)(yi)療機構實行(xing)(xing)按(an)(an)(an)病(bing)(bing)種(zhong)(zhong)付(fu)(fu)(fu)費(fei)(fei)(fei)(fei)，其(qi)按(an)(an)(an)病(bing)(bing)種(zhong)(zhong)付(fu)(fu)(fu)費(fei)(fei)(fei)(fei)的限(xian)額標準為三級醫(yi)(yi)療機構限(xian)額標準的60%，病(bing)(bing)種(zhong)(zhong)范圍(wei)(wei)主(zhu)要是手(shou)術病(bing)(bing)種(zhong)(zhong)，其(qi)他病(bing)(bing)種(zhong)(zhong)待條(tiao)件(jian)成熟(shu)后逐(zhu)步納入(ru)。

　　醫療保(bao)險按(an)病(bing)(bing)種(zhong)付(fu)(fu)(fu)費(fei)(fei)遵照“病(bing)(bing)種(zhong)控制、確保(bao)質量、定額(e)結(jie)(jie)算、結(jie)(jie)余(yu)留用(yong)、超(chao)支不補”的(de)原則結(jie)(jie)算。按(an)病(bing)(bing)種(zhong)付(fu)(fu)(fu)費(fei)(fei)病(bing)(bing)種(zhong)的(de)醫療費(fei)(fei)用(yong)總額(e)分(fen)為統籌金支付(fu)(fu)(fu)額(e)和參保(bao)人員自付(fu)(fu)(fu)額(e)兩(liang)部(bu)分(fen)。參保(bao)人員自付(fu)(fu)(fu)部(bu)分(fen)由(you)患(huan)者在出院時結(jie)(jie)算，統籌金支付(fu)(fu)(fu)部(bu)分(fen)由(you)醫保(bao)經辦機構結(jie)(jie)算。

　　醫療保險按(an)(an)(an)病種(zhong)(zhong)(zhong)付(fu)(fu)費(fei)(fei)(fei)辦法(fa)出臺后(hou)，萊蕪(wu)市各級(ji)醫保經(jing)辦機(ji)(ji)構(gou)(gou)高(gao)度重視，加(jia)強組織領導，建(jian)(jian)立工作機(ji)(ji)制，發(fa)揮好(hao)按(an)(an)(an)病種(zhong)(zhong)(zhong)收付(fu)(fu)費(fei)(fei)(fei)的(de)協調(diao)(diao)(diao)作用，做(zuo)好(hao)政策宣傳(chuan)培訓，建(jian)(jian)立按(an)(an)(an)病種(zhong)(zhong)(zhong)付(fu)(fu)費(fei)(fei)(fei)公示制度，主動接受群眾監督(du)，確(que)保按(an)(an)(an)病種(zhong)(zhong)(zhong)付(fu)(fu)費(fei)(fei)(fei)順利實(shi)施(shi)。各定(ding)點(dian)醫療機(ji)(ji)構(gou)(gou)及時做(zuo)好(hao)了(le)系(xi)統調(diao)(diao)(diao)整(zheng)，按(an)(an)(an)照規定(ding)的(de)病種(zhong)(zhong)(zhong)編(bian)碼(ma)、手術編(bian)碼(ma)及付(fu)(fu)費(fei)(fei)(fei)限額(e)標(biao)準調(diao)(diao)(diao)整(zheng)完善收費(fei)(fei)(fei)系(xi)統，做(zuo)好(hao)與醫保經(jing)辦機(ji)(ji)構(gou)(gou)按(an)(an)(an)病種(zhong)(zhong)(zhong)結算項目對(dui)應，確(que)保按(an)(an)(an)病種(zhong)(zhong)(zhong)付(fu)(fu)費(fei)(fei)(fei)準入與退出的(de)順暢銜接。同時，定(ding)點(dian)醫療機(ji)(ji)構(gou)(gou)建(jian)(jian)立了(le)按(an)(an)(an)病種(zhong)(zhong)(zhong)收費(fei)(fei)(fei)知情(qing)告知書，在保證患者(zhe)的(de)知情(qing)權(quan)、選擇(ze)權(quan)的(de)同時，做(zuo)好(hao)政策解(jie)(jie)釋，讓(rang)患者(zhe)了(le)解(jie)(jie)按(an)(an)(an)病種(zhong)(zhong)(zhong)付(fu)(fu)費(fei)(fei)(fei)的(de)優勢，為推進按(an)(an)(an)病種(zhong)(zhong)(zhong)付(fu)(fu)費(fei)(fei)(fei)實(shi)施(shi)創造良好(hao)環境。