[1]郑丽敏,陈新平,林镇江.以医疗质量为基础的DRG核心要素调整机制研究[J].卫生经济研究,2023,40(8):33-36.
　ZHENG Limin,CHEN Xinping,LIN Zhenjiang.Study on the Adjustment Mechanism for the Core Elements of DRG Payment based on Medical Quality[J].Journal Press of Health Economics Research,2023,40(8):33-36.
点击复制

以医疗质量为基础的DRG核心要素调整机制研究
分享到：

卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
40
期数:
2023年8期
页码:
33-36
栏目:
筹资与支付
出版日期:
2023-07-26

文章信息/Info

Title:
Study on the Adjustment Mechanism for the Core Elements of DRG Payment based on Medical Quality
作者:
郑丽敏1; 陈新平2; 林镇江1
1.福建省南平市第一医院， 福建 南平 353006
2.福建省肿瘤医院， 福建 福州 350014
Author(s):
ZHENG Limin;  CHEN Xinping;  LIN Zhenjiang
Nanping First Hospital, Nanping Fujian 353006, China
关键词:
DRG支付; 医疗质量; 核心要素; 调整机制
Keywords:
DRG payment;  medical quality;  core elements;  adjustment mechanism
分类号:
F840.684
文献标志码:
B
摘要:
以福建省南平市第一医院具体病例DRG结算情况为例，分析DRG核心要素变动引起的医保支付结算差异，认为主要诊断及编码、临床路径、新技术运用、诊疗行为、药品耗材集中采购等要素变动均会影响DRG支付结果。对此，需要建立以医疗质量为基础的DRG核心要素调整机制：加强监管，完善临床路径，探索建立新技术支付制度，推进诊疗行为与医疗费用协同，建立医保支付方式改革与其他医改政策协同机制。
Abstract:
Taking the DRG payment settlement in Nanping First Hospital in Fujian Province as an example, this article analyzes the differences in medical insurance payment settlement caused by changes in core elements of DRG payment, and finds that the changes in major diagnosis and coding, clinical pathway, application of new technology, diagnosis and treatment behavior, centralized procurement of drug and consumables will affect DRG payment results. In this regard, it is necessary to establish an adjustment mechanism for the core elements of DRG payment based on medical quality, strengthen supervision, improve the clinical pathway, explore a new technology payment system, promote the collaboration between diagnosis and treatment behavior and medical expenses, and establish a collaborative mechanism between the reform of medical insurance payment methods and other medical reform policies.

参考文献/References:

[1] 李婵，邹佳，徐焦，等.DRG相对权重调整的思考和启示[J].卫生经济研究，2023，40（1）：46-48，52.
[2] 纪门，孔旭辉，黄秀芹，等.DRG高倍率病例特征分析及管理建议[J].卫生经济研究，2023，40（1）：78-82.
[3] 贺睿博，张亮，殷晓露.DRG实施背景下公立医院高质量发展路径研究[J].中国卫生政策研究，2022，15（10）：1-9.
[4] 沈英，袁波英，王锦毓，等.肝胆胰肿瘤外科DRG入组错误案例分析[J].中国病案，2023，24（1）：34-36.
[5] Shrank W H,Rogstad T L,Parekh N.Waste in the US health care system:estimated costs and potential for savings[J].JAMA-J Am Med Assoc,2019,322(15):1501-1509.
[6] 王国林，曹冬梅，桂成.DRG支付体系下病案首页编码同质化研究[J].卫生经济研究，2022，39（12）：38-40,44.
[7] 魏唯，肖启强，蒋心梅.双重差分模型下DRG付费对住院患者费用负担的影响[J].中国医疗保险，2023（1）：94-97.

相似文献/References:

[1]祝 玲,董子坤.DRG支付下的大数据医保基金监管创新实践[J].卫生经济研究,2021,38(12):37.
　ZHU Ling,DONG Zi-kun.Innovative Practice of Big Data Medical Insurance Fund Supervision under DRG Payment[J].Journal Press of Health Economics Research,2021,38(8):37.
[2]彭 蕾,武 卉,李 军.老年友善医院开展老年医学多学科诊疗的探索[J].卫生经济研究,2022,39(10):83.
　PENG Lei,WU Hui,LI Jun.Exploration of Multidisciplinary Diagnosis and Treatment of Geriatric Medicine in Elderly Friendly Hospitals[J].Journal Press of Health Economics Research,2022,39(8):83.
[3]韩冬青.公立医院实施DRG支付的问题及路径改善研究[J].卫生经济研究,2023,40(5):83.
　HAN Dongqing.Study on the Problems and Improvement Path of Implementing DRG Payment in Public Hospitals[J].Journal Press of Health Economics Research,2023,40(8):83.
[4]石梦潇,王浜琴,王前强.DRG支付下公立医院高质量发展路径的案例研究 ——基于动态能力分析[J].卫生经济研究,2024,41(05):62.
　SHI Mengxiao,WANG Bangqin,WANG Qianqiang.Case Study on the Path of High-quality Development for Public Hospitals under DRG Payment Reform ——Based on Dynamic Capabilities Analysis[J].Journal Press of Health Economics Research,2024,41(8):62.
[5]王 晖,罗兰花.DRG支付下公立中医医院精细化成本管理的 挑战与路径研究[J].卫生经济研究,2024,41(11):58.
　WANG Hui,LUO Lanhua.Study on the Challenge and Path of Refined Cost Management in Public Chinese Medicine Hospitals under DRG Payment[J].Journal Press of Health Economics Research,2024,41(8):58.
[6]司小平.DRG支付对住院患者医疗费用负担的影响研究[J].卫生经济研究,2025,42(01):61.
　SI Xiaoping.Study on Impact of DRG Payment Mode Reform on the Medical Expense Burden of Hospitalized Patients[J].Journal Press of Health Economics Research,2025,42(8):61.
[7]王卉晓,叶腾飞,张 琳.DRG支付下医院医保管理模式探讨[J].卫生经济研究,2025,42(02):77.
　WANG Huixiao,YE Tengfei,ZHANG Lin.Study on Medical Insurance Management Model in Hospitals under DRG Payment[J].Journal Press of Health Economics Research,2025,42(8):77.

更新日期/Last Update: 2023-07-26