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中国全科医学 ›› 2024, Vol. 27 ›› Issue (25): 3083-3090.DOI: 10.12114/j.issn.1007-9572.2023.0725

• 世界全科医学工作研究 • 上一篇    下一篇

美国家庭健康预付费系统的经验及对我国的启示

胡玉红1,2, 郭丽君1,2,*(), 彭向东1,*(), 孙炜3,4,5, 鲍勇3,4,5   

  1. 1.201318　上海市，上海健康医学院护理与健康管理学院
    2.201203　上海市，上海中医药大学研究生院
    3.200030　上海市，上海交通大学健康传播发展中心
    4.200030　上海市，上海交通大学中国城市治理研究院
    5.200030　上海市，上海交通大学行业研究院
  • 收稿日期:2023-09-23 修回日期:2024-01-11 出版日期:2024-09-05 发布日期:2024-06-14
  • 通讯作者: 郭丽君, 彭向东


  • 作者贡献：

    胡玉红、郭丽君负责文章的构思与设计、研究资料的收集与整理、论文撰写；彭向东、孙炜负责表格的编辑、整理；郭丽君、鲍勇负责论文修订、文章的质量控制及审校，对文章整体负责。

  • 基金资助:
    国家重点研发计划(2020YFC2006400); 上海健康医学院护理与健康管理学院学科团队建设项目(22HGXKTD001)

The Experience of the Home Health Prospective Payment System in the United States and Its Enlightenment for China

HU Yuhong1,2, GUO Lijun1,2,*(), PENG Xiangdong1,*(), SUN Wei3,4,5, BAO Yong3,4,5   

  1. 1. School of Nursing and Health Management, Shanghai University of Medicine & Health Sciences, Shanghai 201318, China
    2.Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
    3.Health Communication Development Center, Shanghai Jiaotong University, Shanghai 200030, China
    4.China Institute for Urban Governance, Shanghai Jiaotong University, Shanghai 200030, China
    5.Institute of Industry Research, Shanghai Jiaotong University, Shanghai 200030, China
  • Received:2023-09-23 Revised:2024-01-11 Published:2024-09-05 Online:2024-06-14
  • Contact: GUO Lijun, PENG Xiangdong

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摘要： 基于文献分析法，系统总结美国家庭健康预付费系统（HHPPS）发展历程、分组情况和支付模式。HHPPS从建立之初至今已经发展了三个版本，分组结果更加精细化、科学化，从最初的80个家庭健康资源组增长到432个家庭健康资源组。这种方法可以有效控费，但需要大量的家庭保健数据，需要科学完备的费用结算系统和病案管理系统，在我国现阶段推广实施还存在一定的困难。我国应该借鉴HHPPS，建立一个统一标准化的评估系统，开发和完善居家医疗服务信息收集系统，多方面推动发展居家医疗服务，最终建立一个科学有效的付费模式，让居家医疗服务可持续地发展下去。

关键词: 预付费卫生计划, 家庭保健护理, 家庭健康预付费系统, 居家医疗服务, 支付模式, 美国

Abstract:

Based on literature analysis, the paper systematically summarizes the development history, grouping and payment mode of the Home Health Prospective Payment System (HHPPS) in the United States. The HHPPS has developed three versions since its establishment, and the grouping results are more refined and scientific, from the initial 80 home health resource groups to 432 home health resource groups. This method can effectively control expenses, but it requires a large amount of home health care data, scientific and complete expense settlement system and medical record management system. There are still some difficulties in the promotion and implementation in our country at this stage. Our country should learn from the HHPPS of the American, establish a unified and standardized evaluation system, develop and improve the home medical service information collection system, promote the development of home care services in various aspects, and finally realize the establishment of a scientific and effective payment model, so as to enable the sustainable development of home care service.

Key words: Prepaid health plans, Home health nursing, Home health prospective payment system, Home care services, Payment mode, United States

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