关键词: 结核, 肺, 门诊医疗, 单付费者系统, 可行性研究, 湖南省

Abstract: Objective  To explore the feasibility of implementing case-based payment for outpatient tuberculosis auxillary diagnosis and treatment in Hunan province. Methods  All 131 counties of Hunan province were investigated to obtain the current situation for medical insurance of tuberculosis patients by questionnaire survey and telephone interview. Forty staffs of 10 counties from the new rural cooperative medical system (NRCMS) sectors and centers for disease control and prevention (CDC) were interviewed on the pros and cons of pilot case-based payment for outpatient tuberculosis.  Results  Outpatient TB treatment fee was covered by NRCMS in 118 counties. Reimbursement approaches consist of proportional reimbursement, fixed amount reimbursement and case-based reimbursement. However, the fixed amount reimbursement varies from 200 to 1500 Yuan per case and the proportional reimbursement has a range of 30%-80%. According to the provincial guidance of basic service package, at least 10.14 million Yuan per year need to be input to NRCMS for non-pilot counties to implement the case-based payment policy. Among 6 investigated pilot counties, NRCMS’ fund burden did not show obvious change(increasing by -5%～5%)in 2 counties, slight increase（by 5%-10%） in 3 counties, but significant increase（over 10%）in 1 county after pilot carrying out. Conclusion  The policy of case-based payment for outpatient TB auxiliary diagnosis and treatment can be adapted to local conditions, and gradually expanded and promoted in Hunan province.

Key words: Tuberculosis,pulmonary, Ambulatory care, Single-payer system, Feasibility studies, Hunan province