[1]廖 芳,彭美华,邓世虎,等.DRG基础病组推进分级诊疗的政策效果分析[J].卫生经济研究,2025,42(06):68-72.
　LIAO Fang,PENG Meihua,DENG Shihu,et al.Analysis of the Policy Effect of DRG Basic Disease Group in Promoting Hierarchical Diagnosis and Treatment[J].Journal Press of Health Economics Research,2025,42(06):68-72.
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DRG基础病组推进分级诊疗的政策效果分析

卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
42
期数:
2025年06期
页码:
68-72
栏目:
医疗保障
出版日期:
2025-05-29

文章信息/Info

Title:
Analysis of the Policy Effect of DRG Basic Disease Group in Promoting Hierarchical Diagnosis and Treatment
作者:
廖 芳1; 彭美华1; 邓世虎2; 李 梅2; 周望苏2; 李 希1; 邓朝庭3
1.成都中医药大学管理学院，四川 成都 610075
2.眉山市医疗保障局，四川 眉山 620010
3.上海金仕达卫宁软件科技有限公司，上海 200001
Author(s):
LIAO Fang;  PENG Meihua;  DENG Shihu;  LI Mei;  ZHOU Wangsu;  LI XI;  DENG Chaoting
School of Management, Chengdu University of Traditional Chinese Medicine, Chengdu Sichuan 610075, China
关键词:
DRG支付改革; 基础病组; 同病同价; 分级诊疗
Keywords:
DRG payment reform;  basic disease groups;  same disease and same price;  hierarchical diagnosis and treatment
分类号:
F840.684
文献标志码:
A
摘要:
目的：梳理DRG支付改革地区的基础病组政策，基于样本城市数据评估政策效果，为政策优化提供参考。方法：对比分析DRG支付改革地区基础病组政策差异，基于病例分布、费用标准、效率指数等指标探讨样本城市的政策执行效果。结果：DRG基础病组政策在各地存在差异，目前覆盖地区和病组数量偏少，同质性指标未纳入遴选规则；样本城市政策实施效果有限，对分级诊疗的促进作用尚未显现。结论：通过完善“同病同价同质”遴选标准，动态调整基础病组数量，突破“基层定势”，逐步缩小差异系数等措施，优化DRG基础病组政策，实现与医共体改革、医疗服务价格改革的协同，从而推进分级诊疗。
Abstract:
Objective To summarize the basic disease group policies in DRG payment reform regions, assess the policy effects based on the data of the sample cities, and to provide reference for policy optimization. Methods Comparative analysis was used to comprehensively compare the differences in basic disease group policies in DRG payment reform regions, and the effects of policy implementation were explored in the sample cities based on case distribution, cost standard, efficiency index and other indicators. Results There were differences in DRG basic disease group policies in different sample regions, the number of covered regions and disease groups was small, and homogeneity indexes were not included in the selection rules. The implementation effect of the policies in the sample cities was limited, and the promotion of hierarchical diagnosis and treatment had not yet appeared. Conclusion It is recommended to optimize the basic DRG group by improving the selection criteria of "same disease, same price and same quality", dynamically adjust the number of basic disease groups, break through the "primary stereotype", and gradually narrow the coefficient of variation. The DRG basic disease group policies should be optimized, and cooperate with the reform of the medical community and the price reform of medical services, so as to promote the hierarchical treatment.

参考文献/References:

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更新日期/Last Update: 2025-05-29