[1]朱碧帆,徐嘉婕,桑培敏,等.DRG支付对医疗服务体系的影响分析——基于OECD实证数据[J].卫生经济研究,2021,38(5):49-54.
　ZHU Bi-fan,XU Jia-jie,SANG Pei-min,et al.Analysis on the Impact of DRG Implementation on Medical Service System——Based on the Empirical Data of OECD[J].Journal Press of Health Economics Research,2021,38(5):49-54.
点击复制

DRG支付对医疗服务体系的影响分析
——基于OECD实证数据
分享到：

卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
38
期数:
2021年5期
页码:
49-54
栏目:
卫生服务
出版日期:
2021-04-30

文章信息/Info

Title:
Analysis on the Impact of DRG Implementation on Medical Service System
——Based on the Empirical Data of OECD
作者:
朱碧帆1; 徐嘉婕1; 桑培敏2; 李 芬1
1.上海市卫生和健康发展研究中心(上海市医学科学技术情报研究所)，上海 200041
2.四川省成都市成华区疾病预防控制中心，四川 成都 610057
Author(s):
ZHU Bi-fan;  XU Jia-jie;  SANG Pei-min;  LI Fen
Shanghai Health Development Research Center(Shanghai Medical Information Center), Shanghai 200041, China
关键词:
DRG; 医疗服务体系; 支付方式; 影响分析
Keywords:
DRG;  medical service system;  payment method;  impact analysis
分类号:
F840.684
文献标志码:
A
摘要:
目的：基于OECD国家实证数据，分析DRG支付对医疗服务体系的影响。方法：根据文献研究以及数据可获得性，结合“结构-过程-结果”框架，构建了包含5个维度11个指标的指标体系，分析部分国家实施DRG支付前后各指标的变化情况。结果：实施DRG支付后，大部分国家的千人口床位数、出院后30天死亡率以及平均住院天数有所下降，然而这种下降趋势在引入DRG前就已出现，可能与医疗技术水平的发展有关。结论：DRG支付对控制医疗费用的影响较为有限，且在不同的医疗体系下可能产生不同的结局，需出台相应的监管措施，以达到预期的控费效果。
Abstract:
Objective Based on the empirical data of OECD countries, this paper analyzes the impact of DRG implementation on the medical service system. Methods According to the literature research and data availability, combined with the "structure-process-outcome" framework, this paper constructs an index system with 5 dimensions and 11 indicators, and analyzes the changes of each index before and after the DRG payment system implementation in some countries. Results After the DRG implementation, the number of beds for a thousand people, the mortality rate of 30 days after discharge and the average length of stay in hospital have decreased in most countries. However, this downward trend has occurred before the DRG application, which may be related to medical technology development in hospital. Conclusion In short, the influence of DRG payment system on the control of medical expenses is limited, and it may have different outcomes under different medical systems, so it is necessary to formulate corresponding regulatory measures to achieve the expected effect of fee control.

参考文献/References:

[1] 彭颖，金春林，王贺男.美国DRG付费制度改革经验及启示[J]. 中国卫生经济，2018（7）：93-96.
[2] Office of Inspector General,Office of Evaluation and Inspections. Medicare Hospital Prospective Payment System：How DRG Rates Are Calculated and Updated[EB/OL].[2017-10-19].http://oig.hhs.gov/oei/reports/oei-09-00-00200.pdf.
[3] Busse R,Geissler A,Aaviksoo A,et al.Diagnosis related groups in Europe:moving towards transparency,efficiency,and quality in hospitals?[J].BMJ,2013,346(7):f3197-f3197.
[4] OECD/WHO(2015).Case-based Payment Systems for Hospital Funding in Asia:An Investigation of Current Status and Future Directions,WTO,Geneva,https://doi.org/10.1787/9789290617327-en.
[5] MihailovicN,Kocic S, Jakovljevic M.Review of Diagnosis-Related Group-Based Financing of Hospital Care[J].Health Services Research and Managerial Epidemiology, 2016(3):1-8.
[6] GutermanS, Eggers P W,Riley G,et al.The first 3 years of Medicare prospective payment:An overview[J].Health care financing review,1988, 9(3):67-77.
[7] Manton K G,Woodbury M A,Vertrees J C,et al.Use of Medicare Services Before and After Introduction of the Prospective Payment System[J].Health Services Research,1993, 28(3):269-292.
[8] EtteltS,Thomson S,Nolte E,et al.Reimbursing highly specialised hospital services:the experience of activity-based funding in eight countries[J].2006.
[9] Cots F,LlucMercadé,Castells X,et al.Relationship between hospital structural level and length of stay outliers:Implications for hospital payment systems[J].Health Policy,2004,68(2):1-168.
[10] Farrar S,Yi D, Sutton M,et al.Has payment by results affected the way that English hospitals provide care?Difference-in-differences analysis[J].BMJ (online),2009,339(7720):b3047.
[11] Hamada H,Sekimoto M,Imanaka Y.Effects of the per diem prospective payment system with DRG-like grouping system (DPC/PDPS) on resource usage and healthcare quality in Japan[J].Health Policy,2012,107(2-3):194-201.
[12] Jian W,Lu M,Chan K,et al.Payment reform pilot in Beijing hospitals reduced expenditures and out-of-pocket payment per admission[J].Health affairs,2015,34(10):1745-1752.
[13] 冯虹，张玉玺. DRGs试点的住院费用控制效果分析与推行建议[J].北京联合大学学报(人文社会科学版)，2019（3）：116-124.
[14] PanagiotopoulosP,Maniadakis N,Papatheodoridis G,et al.An Evaluation of Diagnosis-Related Group(DRG) Implementation Focused on Cancer DRGs in Greek Public Hospitals[J].2019(4):61-69.
[15] Hamada H,Sekimoto M,Imanaka Y.Effects of the per diem prospective payment system with DRG-like grouping system (DPC/PDPS) on resource usage and healthcare quality in Japan[J].Health Policy,2012,107(2-3):194-201.
[16] Margrit Fssler,Wild V,Clarinval C,et al.Impact of the DRG-based reimbursement system on patient care and professional practise:Perspectives of Swiss hospital physicians[J].Swiss medical weekly,2015,145:w14080.
[17] Choi,J.W.,Kim,S.,Park,H.et al.Effects of a mandatory DRG payment system in South Korea:Analysis of multi-year nationwide hospital claims data[J].BMC Health Serv Res,2019,19:776.https://doi.org/10.1186/s12913-019-4650-8.
[18] Lave,J.R.The effect of the Medicare prospective payment system[J].Annual Review of Public Health,1989,10:141-161.
[19] Palmer K S,Agoritsas T,Martin D,et al.Activity-based funding of hospitals and its impact on mortality,readmission,discharge destination, severity of illness, and volume of care: a systematic review and meta-analysis[J]. 2014, 10(3):e0121163.
[20] 农雯琦.DRGs付费制对医院运营指标的影响——以L医院为例[J]. 中国总会计师，2019（9）：78-80.
[21] Yuan S,Liu W,Wei F,et al.Impacts of Hospital Payment Based on Diagnosis Related Groups (DRGs) with Global Budget on Resource Use and Quality of Care:A Case Study in China[J].Iran J Public Health,2019,48(2):238-246.
[22] 李菲.DRGs在医院医疗费用支付中的应用研究——基于英国、德国和美国的实证分析[J].卫生经济研究，2019，36（1）：34-39.
[23] OECD iLibrary.OECD Health Statitics [EB/OL].https://www.oecd-ilibrary.org/social-issues-migration-health/data/oecd-health-statistics_health-data-en.
[24] OECD.Glossary of Statistical Terms [EB/OL].https://stats.oecd.org/glossary/detail.asp?ID=6156.
[25] 邓绍平，刘小明，等.以发达国家经验分析我国医院病床供需变化趋势[J].卫生经济研究，2015，（4）28-36.

相似文献/References:

[1]章维青,叶 青,林远巨,等.县域医疗服务共同体的实践路径探索——以仙居县为例[J].卫生经济研究,2018,(12):14.
　ZHANG Wei-qing,YE Qing,LIN Yuan-ju,et al.Exploring the Practice Path of County Medical Service Community——Taking Xianju County as An Example[J].Journal Press of Health Economics Research,2018,(5):14.
[2]丛鹂萱,王海银,金春林.美国创新医疗技术支付经验及启示[J].卫生经济研究,2019,(07):10.
　CONG Li-xuan,WANG Hai-yin,JIN Chun-lin.American Innovative Medical Technology Payment Experience and Enlightenment[J].Journal Press of Health Economics Research,2019,(5):10.
[3]潘春燕.DRG支付方式的实践探讨——以JH市试点情况为例[J].卫生经济研究,2019,(08):38.
　PAN Chun-yan.Discussion on the Practice of DRG Payment Method——Taking the Pilot of JH City as an example[J].Journal Press of Health Economics Research,2019,(5):38.
[4]高 菁,崔 斌,朱兆芳,等.收付费双轨制改革对医院财务管理的影响[J].卫生经济研究,2019,(09):68.
　GAO Jing,CUI Bin,ZHU Zhao-fang,et al.The Impact of the Dual-track Reform of Payment on Hospital Financial Management[J].Journal Press of Health Economics Research,2019,(5):68.
[5]刘荣飞,薛 梅,李紫灵.DRG的国内外研究进展[J].卫生经济研究,2020,(10):42.
　LIU Rong-fei,XUE Mei,LI Zi-ling.Research Progress of DRG at Home and Abroad[J].Journal Press of Health Economics Research,2020,(5):42.
[6]田雪晴,廖子锐,汤昊宬,等.基于变革理论的远程医疗服务体系建设研究[J].卫生经济研究,2021,38(2):41.
　TIAN Xue-qing,LIAO Zi-rui,TANG Hao-cheng,et al.Research on the Construction of Telemedicine Service System Based on Theory of Change[J].Journal Press of Health Economics Research,2021,38(5):41.
[7]杨 棋,庚 硕,刘 瑾,等.公立医院RBRVS与DRG管理工具结合应用的思考——基于绩效管理视角[J].卫生经济研究,2021,38(3):57.
　YANG Qi,GENG Shuo,LIU Jin,et al.Thoughts on the Combined Application of RBRVS and DRG Management Tools in Public Hospitals——From the Perspective of Performance Management[J].Journal Press of Health Economics Research,2021,38(5):57.
[8]李文瑾,续晓方,田立启,等.基于DRG的乳腺癌手术患者住院费用及影响因素分析[J].卫生经济研究,2021,38(6):76.
　LI Wen-jin,XU Xiao-fang,TIAN Li-qi,et al.Analysis on Hospitalization Expenses and Its Influencing Factors of Breast Cancer Patients Based on DRG[J].Journal Press of Health Economics Research,2021,38(5):76.
[9]赵 迪,王孝勇,郭 磊,等.基于DRG的病组成本核算方法研究[J].卫生经济研究,2021,38(9):65.
　ZHAO Di,WANG Xiao-yong,GUO Lei,et al.Research on DRG-based Cost Accounting Method of Disease Group[J].Journal Press of Health Economics Research,2021,38(5):65.
[10]于 磊,吴佳勉,熊小兰,等.基于DRG的急性心肌梗死患者分组效果评价与费用分析[J].卫生经济研究,2021,38(10):35.
　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(5):35.

更新日期/Last Update: 2021-04-30