沙特账单系统的发展支持国家卫生转型:方法和理由
Husein Reka1, Deniza Mazevska2, Jim Pearse2
1Council of Health Insurance, Riyadh, Saudi Arabia. hureka@gmail.com.
BMC health services research
|April 11, 2025
概括
沙特账单系统 (SBS) 的发展标准化了医疗保健账单代码,提高了透明度,并支持沙特阿拉伯的基于价值的护理. 这个新系统将代码集增加了30%以改善案例组合的理解.
科学领域:
- 医疗信息学 医疗信息学
- 卫生经济学 卫生经济学
- 卫生政策 卫生政策
背景情况:
- 沙特卫生转型计划改革包括医疗保健融资.
- 医疗保险委员会 (CHI) 旨在通过患者分类和数据标准化实现透明度.
- 以前的私人医疗保险部门使用了非标准化的计费代码,阻碍了透明度和基于价值的医疗保健 (VBHC).
研究的目的:
- 引入标准化的计费代码:沙特计费系统 (SBS).
- 提高沙特私人医疗保险部门的透明度和案例组合的理解.
- 支持向基于价值的医疗保健 (VBHC) 融资模式的过渡.
主要方法:
- 审查和评估各种患者分类和计费系统.
- 收集了来自三家主要医疗保险公司的数据,涵盖80个医疗保健提供者.
- 使用澳大利亚卫生干预分类 (ACHI) 第10版重新编码了36299名患者记录的样本,并进行了随后的审计.
主要成果:
- 75%的记录被映射到现有的ACHI代码;25%需要修改 (1%部分,22%近似,2%其他).
- 修改了 ACHI 代码并添加了新的代码,以完全兼容计费实践,创建了沙特计费系统 (SBS).
- 将代码集扩展了1774个代码,总共有7947个SBS代码 (比ACHI第10版增加了30%).
结论:
- 标准化的计费系统对于医疗保健透明度和融资至关重要.
- 适应私人医疗保险市场现有的国家患者分类和编码标准,以满足VBHC要求.
- 强制性患者分类系统为适应国家医疗保健转型和推进透明度和VBHC提供了基础.
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