不同医疗保险支付方式对临床路径管理实施效果的影响

目的：探讨不同医疗保险支付方式对实施临床路径管理的影响。方法从2014年1-2月河北北方学院附属第一医院收治的2型糖尿病、慢性鼻-鼻窦炎、胆囊结石腹腔镜胆囊切除术患者中随机选择200例，按医疗保险支付方式的不同分为观察组和对照组，每组100例。观察组实行按病种付费制，对照组实行按总额预付制，两组均实施临床路径管理。比较两组住院时间、住院费用，以及患者对疾病的掌握程度、满意度。结果观察组患者住院费用明显少于对照组，住院时间显著短于对照组，差异均有统计学意义（均P〈0.05）；观察组患者知识掌握得分为（94.4±1.8）分，对照组患者知识掌握得分为（84.3±0.7）分，差异有统计学意义（P〈0.05）；观察组患者满意度为94%，明显高于对照组的76%，差异有统计学差异（P〈0.05）。结论按病种付费制度的医疗保险模式可为患者缩短医疗时间，节约医疗成本，与临床实施临床路径管理互相促进，值得临床推广。

Effects of different medical insurance payment in the implementation of clinical pathway management

Objective To investigate the effects of different medical insurance payment on the implementation of clini-cal pathway management. Methods 200 cases of patients with type 2 diabetes mellitus, chronic rhinosinusitis, gallstone undergoing laparoscopic cholecystectomy from January to February 2014 in the First Affiliated Hospital of Hebei North University were randomly selected. According to the medical insurance payment, the cases were divided into observa-tion group and control group, 100 cases in each group. Observation group was given payment by type of disease, control group was given the total amount of the advance system. The two groups were given clinical pathway management. The hospitalization days, hospitalization expenses, mastery degree of knowledge, satisfaction in two groups were compared. Results The hospitalization expenses in the observation group was significantly lower than the control group, hospital-ization time was shorter than control group, the differences were all statistically significant （P〈0.05）. The mastery de-gree of knowledge in the observation group was （94.4±1.8） scores, which in the control group was （84.3±0.7） scores, the difference was statistically significant （P〈0.05）. The satisfaction degree was 94%in the observation group, significant-ly higher than that in the control group （76%）, the difference was statistically significant （P〈0.05）. Conclusion The mode of medical insurance payment system can shorten the medical time-out and save medical cost for patients, also can promote clinical pathway management. It is worthy of clinical promotion.