[1]王 聪,张立佳,陈 钰,等.公立医院病例组合指数影响机制与考评路径研究[J].卫生经济研究,2026,43(09):64-67.
　WANG Cong,ZHANG Lijia,CHEN Yu,et al.Research on the Impact Mechanism and Evaluation Pathway of Case Mix Index (CMI) in Public Hospitals[J].Journal Press of Health Economics Research,2026,43(09):64-67.
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公立医院病例组合指数影响机制与考评路径研究

卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
43
期数:
2026年09期
页码:
64-67
栏目:
医院管理
出版日期:
2026-09-02

文章信息/Info

Title:
Research on the Impact Mechanism and Evaluation Pathway of Case Mix Index (CMI) in Public Hospitals
作者:
王 聪1; 张立佳1; 陈 钰1; 鹿 鹏1; 田 甜1; 但秀娟1
1.中国人民解放军总医院第四医学中心，北京 100048
Author(s):
WANG Cong;  ZHANG Lijia;  CHEN Yu;  LU Peng;  TIAN Tian;  DAN Xiujuan
The Fourth Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100048, China
关键词:
CMI; DRG; 分位数; 贡献度; 考评体系
Keywords:
CMI;  DRG;  quantile;  contribution degree;  evaluation system
分类号:
R197.323
文献标志码:
A
摘要:
目的：在DRG支付下，分析病例组合指数（CMI）的影响机制，并设计合理的考评体系，体现医务人员的劳务价值。方法：基于案例医院近3年的运营数据，构建双向固定效应回归模型揭示CMI的影响机制；引入分位数理念与相对贡献度，设计科学的CMI考评路径。结果：CMI“四维”成因模型分析显示，政策驱动力、病种结构力、技术支撑力和管理调控力与CMI提升呈显著正向关联（P<0.01）；建立“目标值对标—贡献度激励”的复合考评体系，能够合理评价科室贡献和医务人员的劳务价值。结论：为提高CMI，医院可建立“CMI—成本—效益”三维评估机制，优化病案首页质控流程，推行“目标值对标—贡献度激励”考评体系，对超额贡献科室给予资源倾斜；但需防范掉入“高CMI陷阱”，可通过联动医疗安全评价来控制过度医疗行为，以保留公益性病种收治能力，最终保障患者权益。
Abstract:
Objective To analyze the impact mechanism of CMI under DRG payment and design a reasonable evaluation system to reflect the service value of medical personnel. Methods Based on operational data from a case hospital over the past three years, a two-way fixed-effects regression model was constructed to reveal the impact mechanism of CMI. Quantile concepts and relative contribution degree were introduced to design a scientific CMI evaluation pathway. Results The "four-dimensional" causal model analysis showed that policy driving force, disease structure force, technical support force, and management regulation force were significantly positively associated with CMI improvement(P<0.01). A composite evaluation system of "target value benchmarking-contribution incentive" was established, which could reasonably evaluate departmental contributions and the service value of medical personnel. Conclusion To improve CMI, hospitals can establish a "CMI-cost-benefit" three-dimensional evaluation mechanism, optimize the quality control process of medical record front pages, implement the "target value benchmarking-contribution incentive" evaluation system, and provide resource support to departments with excess contributions. However, caution should be taken to avoid falling into the "high CMI trap". This can be achieved by linking with medical safety evaluations to control excessive medical behaviors, maintaining the capacity to treat public welfare disease categories, and ultimately safeguarding patient rights.

参考文献/References:

[1] 郑秉文.我国医保支付方式改革：现状、挑战与趋势[J].人民论坛,2025（05）：44-50.
[2] 廖藏宜，荆欧杰，惠文.医保DRG付费改革对医疗服务价值的促进作用——来自H市的证据[J].财经问题研究,2024（11）：89-103.
[3] 程潇，唐昌敏，方鹏骞.我国“十四五”期间医院卫生人力资源发展战略及实现路径探析[J].中国医院，2021，25（05）：10-13.
[4] 张明,孙晖,胡豫,等.高质量发展视角下公立医院新文化体系建设路径探析[J].中国医院管理，2022，42（08）：10-12.
[5] 袁莎莎，孟庆跃.医疗服务质量和费用关系的国际研究综述[J].中国卫生政策研究，2014，7（10）：46-51.
[6] 综合医院实体化专病中心建设路径专家共识（2025版）[J/OL].中国循证医学杂志，1-9[2025-11-04].https://link.cnki.net/urlid/51. 1656.R.20251027.1538.004.
[7] 颜珂，王崟欣，强郁文.用好医保基金减轻就医负担[N].人民日报,2024-11-22（013）.
[8] 纪灏，刘媛，于佳，等.基于DRGs病例组合指数和相对权重的胸外科ICU医院感染研究[J].中国感染控制杂志，2024，23（01）：78-85.
[9] 何思长，杨长皓，应嘉川,等.基于DRG的分级诊疗实现路径研究[J].卫生经济研究，2020，37（04）：30-32.
[10] 李浩，陶红兵.DRG下低码高编的制度环境、逻辑动机及形成机制：一个“压力—矛盾”转移视角[J].社会保障研究，2022（06）：64-77.
[11] 杜怿，李灿，方刚，等.医保药物经济性评价质量评估量表研究及启示[J].卫生经济研究，2020，37（06）：28-32.

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　YU Lei,WU Jia-mian,XIONG Xiao-lan,et al.Evaluation of Grouping Effect and Cost Analysis of Patients with Acute Myocardial Infarction Based on DRG[J].Journal Press of Health Economics Research,2021,38(09):35.
[10]石连忠,梅 彦,余 震,等.杭州市DRG中医支付政策的实践探索[J].卫生经济研究,2021,38(12):16.
　SHI Lian-zhong,MEI Yan,YU Zhen,et al.Practical Exploration of DRG Payment Policy for Traditional Chinese Medicine in Hangzhou[J].Journal Press of Health Economics Research,2021,38(09):16.

更新日期/Last Update: 2026-09-02