[1]戴卫东,朱璇格,叶 鑫.衢州市DRG支付改革成效与治理经验[J].卫生经济研究,2023,40(11):8-11.
　DAI Weidong,ZHU Xuange,YE Xin.Effectiveness and Governance Experience of DRG Payment Reform in Quzhou City[J].Journal Press of Health Economics Research,2023,40(11):8-11.
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衢州市DRG支付改革成效与治理经验
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卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
40
期数:
2023年11期
页码:
8-11
栏目:
医疗保障
出版日期:
2023-10-25

文章信息/Info

Title:
Effectiveness and Governance Experience of DRG Payment Reform in Quzhou City
作者:
戴卫东1; 2; 朱璇格1; 叶 鑫3
1.浙江财经大学公共管理学院，浙江 杭州 310018
2.浙江省新型重点专业智库“中国政府监管与公共政策研究院”，浙江 杭州 310018
Author(s):
DAI Weidong;  ZHU Xuange;  YE Xin
School of Public Management, Zhejiang University of Finance and Economics,Hangzhou Zhejiang 310018, China
关键词:
医保支付方式; DRG; 医保控费; 衢州市
Keywords:
medical insurance payment method;  DRG;  medical insurance control fees;  Quzhou city
分类号:
F840.684
文献标志码:
A
摘要:
目的：分析衢州市DRG支付改革的成效和治理经验，为各地推进DRG支付改革提供借鉴。方法：采用描述性统计、文献研究和访谈法，分析衢州市DRG支付改革做法和成效。结果：实行DRG支付改革后，衢州市医疗费用高速增长势头得到有效遏制，医保基金“扭亏为盈”；倒逼医疗机构规范管理，提高医疗服务水平；病床周转率大幅提高，参保患者次均医疗费用和个人自付比例大幅下降。结论：衢州市通过科学制定医保基金核算方法、尊重医疗逻辑调整DRG点数、重视医保基金监管、完善医保信息系统，DRG支付改革取得一定的成效；未来应继续提升病案精细化管理水平，统筹推进区域间DRG支付改革，健全约束激励机制。
Abstract:
Objective To analyze effectiveness and governance experience of DRG payment reform in Quzhou city, and to provide reference for promoting DRG payment reform in various regions. Methods Comparative analysis, literature analysis and interview methods were used to analyze the practices and effectiveness of DRG payment reform in Quzhou city. Results After the implementation of DRG payment reform, the rapid growth of medical expenses in Quzhou city has been effectively curbed, and the medical insurance fund has shifted from losses to profits. Medical institutions are forced to standardize management and improve the level of medical services. The turnover rate of hospital beds has significantly increased, and the average medical expenses and personal self-payment ratio of insured patients have significantly decreased. Conclusion By scientifically formulating accounting methods for medical insurance fund, applying medical logic to adjust DRG points, emphasizing medical insurance fund supervision, and improving the medical insurance information system, the DRG payment reform in Quzhou city has achieved certain results. In the future, it is necessary to continue to improve the level of refined medical record management, coordinate the promotion of inter-regional DRG payment reform, and improve the constraint and incentive mechanism.

参考文献/References:

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更新日期/Last Update: 2023-10-25