精神卫生服务医保混合支付方式改革现状及可行性探讨

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Abstract ObjectiveTo explore the combination and implementation challenges of medical insurance payment methods for mental health services，and to propose recommendations for advancing the reform of mixed payment methods in mental health services.MethodsThrough questionnaire surveys and qualitative interviews conducted in l31 mental health institutions across China，combined with word cloud analysis and non一parametric tests，this study analyzedthe curent status of medical insurance payment methods for mental health services，theawareness of these methods，the evaluation of implementing DRG/DIP.ResultsThe curent main payment methods were perdiem payment （204 （52.0% ）and fee—for-service （29.1% ）； the acceptability of the mixed payment model was 13.3% . The main challenges in implementing DRG/DIP included recurrent mental illnesses （82.4% ），long—term hospitalization （80.9% ），comorbidities （67.9%） ，and difficulties in precise grouping （62.6%） . Secondary mental health specialty hospitals scored significantly higher than other levels in terms of the difficulty of implementing DRG/DIP （ P=0. 01 ）. Price，payment mechanisms，and bed resources Were identified as core factors for enhancing service capacity.ConclusionExploring mixed payment models thatcombine case-based payment，fee-for-service，or per diem payment，integrating social medical insurance with commercial insurance，strengtheningtiered diagnosis and treatment guidance，improving bed utilizationefficiency，andoptimizing costcalculation mechanisms willcontribute tosystematically enhancing the supplylevel and efficiency of mental health services.

Key words Mental Services；Medical Insurance；Mixed Payment Methods；Diagnosis Related Groups （DRG）; Diagnosis—Intervention Packet （DIP）

精神障碍是严重危害当今社会的疾病之一。（剩余7036字）