[1]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(4):24-27,32.
　YANG Song,WU Jing-wen,YU Li-jun,et al.Current Situation and Policy Optimization of DRG High-Rate Cases[J].Journal Press of Health Economics Research,2022,39(4):24-27,32.
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DRG高倍率病例现状与政策优化思考
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卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
39
期数:
2022年4期
页码:
24-27,32
栏目:
专题
出版日期:
2022-03-28

文章信息/Info

Title:
Current Situation and Policy Optimization of DRG High-Rate Cases
作者:
杨 松1; 吴婧文2; 余丽君2; 朱旭林1; 许斯略3; 周小林3; 彭美华1
1.成都中医药大学管理学院，四川 成都 611137
2.四川省眉山市医疗保障局，四川 眉山 620020
3.上海金仕达卫宁软件科技有限公司，上海 200040
Author(s):
YANG Song;  WU Jing-wen;  YU Li-jun;  ZHU Xu-lin;  XU Si-lue;  ZHOU Xiao-lin;  PENG Mei-hua
School of Management, Chengdu University of Tradition Chinese Medicine, Chengdu Sichuan 611137, China
关键词:
DRG; 高倍率病例; 靶点监管; 政策优化
Keywords:
DRG;  high-rate cases;  target monitoring;  policy optimization
分类号:
F840.684
文献标志码:
A
摘要:
以四川省眉山市为例，通过现状分析，发现DRG高倍率筛选机制不合理，医院的病案编码能力和医疗服务能力不足，存在道德风险，低权重病例更易产生高倍率等问题。为了实现合理补偿，鼓励新技术发展，提出相应建议：探索建立权重与费用相结合的筛选机制、靶点监管机制和退费机制，协同高倍率政策的审核和特病单议机制，提高医院的病案编码能力和医疗服务能力，规范执行临床路径。
Abstract:
Taking Meishan City, Sichuan Province as an example, this study analyzed the current situation of DRG high-rated cases. This study found that the screening mechanism of DRG high-rate cases was unreasonable, and the hospital's medical record coding ability and medical service ability were insufficient. It was likely to appear moral hazard, and high-rate problem was more possible to happen in low-weight cases. In order to achieve reasonable compensation and encourage the development of new technologies, it is suggested to explore the establishment of a screening mechanism combining weights and costs, a target monitoring mechanism, a refund mechanism, an audit mechanism which coordinates with high-rate policies, and a mechanism of specific discussion on special diseases. Hospitals should improve the ability of medical record coding and medical service, and standardize the implementation of clinical paths.

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更新日期/Last Update: 2022-03-28