[1]裘凯音,王 佳,王伟红,等.市级统筹背景下DRG付费的公平性研究[J].卫生经济研究,2021,38(12):33-36,40.
　QIU Kai-yin,WANG Jia,WANG Wei-hong,et al.Research on the Fairness of DRG Payment at the Municipal Level[J].Journal Press of Health Economics Research,2021,38(12):33-36,40.
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市级统筹背景下DRG付费的公平性研究
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卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
38
期数:
2021年12期
页码:
33-36,40
栏目:
地市经验
出版日期:
2021-12-02

文章信息/Info

Title:
Research on the Fairness of DRG Payment at the Municipal Level
作者:
裘凯音1; 王 佳1; 王伟红1; 王 晓1; 高 超1; 张可扬1
1.浙江省绍兴市医疗保障局，浙江 绍兴 312000
Author(s):
QIU Kai-yin;  WANG Jia;  WANG Wei-hong;  WANG Xiao;  GAO Chao;  ZHANG Ke-yang
Medical Security Bureau of Zhejiang Shaoxing, Shaoxing Zhejiang 312000, China
关键词:
市级统筹; DRG付费; 泰尔指数; 医保支付; 公平性
Keywords:
municipal level;  DRG payment;  Theil index;  health insurance payment;  fairness
分类号:
R197
文献标志码:
A
摘要:
目的：研究不同医保支付方式和统筹层次对医保支付公平性的影响。方法：以绍兴市2020年住院医疗服务数据为基础，采用按项目付费和县级统筹、区域统筹、市级统筹下的DRG付费四种医保支付方案进行模拟结算，通过泰尔指数检验不同方案的公平性。结果：DRG付费和统筹层次的提高，改善了医保支付的公平性；随着统筹层次的提高，统筹区间和不同层级医院之间的医保支付差异逐渐减小，医保基金共济作用显现；职工医保中，DRG付费提高了不同等级医院之间的医保支付差异；不同支付方案下，中医医院和非中医医院之间的医保支付差异没有明显变化。结论：提高付费预算编制层级，发挥基金共济作用；设置无差异系数病组，提升基层诊疗能力；优化中医支付政策，使中医特色优势得以发挥。
Abstract:
Objective To study the impact of different medical insurance payment methods and pooling levels on the fairness of medical insurance payment. Methods Based on the inpatient medical service data of Shaoxing City in 2020, four medical insurance payment schemes including payment by project and DRG payment under county-level, regional-level, and city-level pooling were adopted for simulated settlement, and the fairness of different schemes was tested by Theil index. Results The improvement of DRG payment and pooling level improved the fairness of medical insurance payment. With the improvement of pooling level, the difference of medical insurance payment between pooling interval and different levels of hospitals was gradually reduced, and the mutuality effect of medical insurance fund was obvious. In employee medical insurance, DRG payment increased the difference of medical insurance payment among different levels of hospitals. Under different payment schemes, there was no significant change in the difference in medical insurance payment between traditional Chinese medicine hospitals and non-traditional Chinese medicine hospitals. Conclusion Improve the level of payment budget and give full play to the mutuality effect of fund; set up a disease group with no difference coefficient to improve the ability of primary diagnosis and treatment; optimize the payment policy of traditional Chinese medicine to give full play to the advantages of traditional Chinese medicine.

参考文献/References:

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更新日期/Last Update: 2021-12-02