[1]林振威,吴风琴,程 斌,等.DRG付费下医生异化行为监管的实践及思考[J].卫生经济研究,2024,41(11):36-39.
　LIN Zhenwei,WU Fengqin,CHENG Bin,et al.Practice and Reflection on the Supervision of Doctor Alienated Behaviors under DRG Payment[J].Journal Press of Health Economics Research,2024,41(11):36-39.
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DRG付费下医生异化行为监管的实践及思考
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卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
41
期数:
2024年11期
页码:
36-39
栏目:
医疗保障
出版日期:
2024-10-31

文章信息/Info

Title:
Practice and Reflection on the Supervision of Doctor Alienated Behaviors under DRG Payment
作者:
林振威1; 吴风琴1; 程 斌1; 许晨虹1; 虞丽娟1; 陈 洁1; 2
1.浙江省肿瘤医院，浙江 杭州 310022
2.浙江省省级医院管理中心，浙江 杭州 310002
Author(s):
LIN Zhenwei;  WU Fengqin;  CHENG Bin;  XU Chenhong;  YU Lijuan;  CHEN Jie
Zhejiang Cancer Hospital, Hangzhou Zhejiang 310022, China
关键词:
DRG付费; 异化行为; 医保基金监管
Keywords:
DRG payment;  alienated behaviors;  supervision of medical insurance fund
分类号:
R19
文献标志码:
A
摘要:
目的：探讨DRG付费下医生异化行为的监管策略，为医保部门加强监管提供参考。方法：分析DRG付费下医生异化行为的典型表现和原因，以样本医院为例，总结医院加强医生异化行为监管的做法和成效。结果：与2020年相比，2023年样本医院被扣减病例数减少215例，扣款金额减少338.57万元，15日内再入院病例从567例减少到208例。结论：DRG付费下，医院应构建全方位监管体系，关联资源消耗，加强智能审核，确定DRG监管靶点，进行精准管控，完善绩效考核方案，减少医生异化行为，促进医院高质量发展。
Abstract:
Objective To explore supervision strategies for doctor alienated behaviors under DRG payment, and to provide reference for medical insurance departments to strengthen supervision. Methods The typical manifestations and reasons for doctor alienated behaviors under DRG payment were analyzed. Taking the sample hospital as an example, the practices and effectiveness of the hospital in strengthening the supervision of doctor alienated behaviors were summarized. Results Compared with 2020, the number of cases identified as violating regulations in the sample hospital in 2023 decreased by 215, the deducted amount decreased by 3.3857 million yuan, and the number of readmission cases within 15 days decreased from 567 to 208. Conclusion Under DRG payment, hospitals should establish a comprehensive supervision system, link resource consumption, strengthen intelligent auditing, determine DRG supervision targets, carry out precise control, improve performance evaluation plans, reduce doctor alienated behaviors, and promote high-quality development of hospitals.

参考文献/References:

[1] 李浩，陶红兵.DRG付费下医方低码高编行为界定与潜在风险研究[J].卫生经济研究，2022，39（04）：28-32.
[2] 王国林，曹冬梅，陶源.医院病案编码员道德风险的行为方式分析及防范[J].医学与哲学，2023，44（08）：34-38.
[4] 陈双慧，肖馨怡，吴海波.DRG改革背景下负向医疗行为的成因分析及治理策略[J].医学与哲学，2022，43（20）：37-40.
[3] Cressey DR.The criminal violation of financial trust[J].ASR,1950,15(06):738-743.
[5] 丁利，董彦平，赵霞. DRG预付费视角下医保结算清单与病案首页差异性分析[J].中国社会医学杂志，2023，40（05）：614-618.
[6] 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)：37-40.
[7] 杨松，吴婧文，余丽君，等.DRG高倍率病例现状与政策优化思考[J].卫生经济研究，2022，39（04）：24-27，32.

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更新日期/Last Update: 2024-10-31