眼科学报2026，Vol.41Issue(7)：568-576,9.DOI:10.12419/25102203
价值医疗导向下不同支付方式在新生血管眼病治疗中的应用和评价
A value-based comparative evaluation of health insurance payment models for neovascular eye diseases
摘要
Abstract
Objective:Guided by the value-based healthcare principles,this study compares different medical insurance payment models for neovascular eye diseases to identify the optimal reimbursement strategy.Methods:Data were collected from patients treated for neovascular eye diseases with completed medical insurance settlements at Zhongshan Ophthalmic Center,Sun Yat-sen University,between January 2024 and June 2025.Patient demographics and insurance types were compared using Chi-square tests.Total medical costs and out-of-pocket expenses across payment methods were evaluated through descriptive statistics and comparative cost analysis.Differences in insurance fund expenditures were assessed using the Mann-Whitney U test.Results:The total medical expenses for hospitalized patients are the highest(5 906.02-6 663.03 yuan),whereas the out-of-pocket payments for patients under specific outpatient settlements are the lowest(1 018.73-1 872.53 yuan).The difference in medical insurance expenditure between hospitalization and specific outpatient settlements is statistically significant(P<0.05),with specific outpatient settlements being lower than hospitalization.Conclusions:Given the clinical management characteristics of neovascular eye diseases,the specific outpatient settlement minimizes patient out-of-pocket costs and reduces insurance expenditures compared to inpatient care.This model represents the optimal payment strategy,effectively maximizing the efficiency of limited insurance funds while alleviating patient financial burden.Broader implementation of this approach is recommended.关键词
医保支付方式/新生血管眼病/价值医疗/特定门诊结算/医保基金支出Key words
medical insurance payment model/neovascular eye disease/value-based healthcare/special outpatient reimbursement/insurance fund expenditure分类
医药卫生引用本文复制引用
郭诗欣,苏淑清,林子媚,魏誉民..价值医疗导向下不同支付方式在新生血管眼病治疗中的应用和评价[J].眼科学报,2026,41(7):568-576,9.基金项目
广东省卫生经济学会2024年科研课题立项(2024-WJMZ-24).This work was supported by 2024 Scientific Research Project Initiation of Guangdong Provincial Health Economics Society(2024-WJMZ-24). （2024-WJMZ-24）
