总额预付制与DRGS两种资金补偿机制分析与借鉴  

Analysis and reference of the two fund compensation policies: the total pre-service payment and diagnosis related groups

作　　者：黄小琼[1] 陈燕燕[1] 陈华蓉[1] 陈辛红[1] 张赛今[1] 

机构地区：[1]温州医科大学附属眼视光医院

出　　处：《中国医院》2014年第12期70-71,共2页Chinese Hospitals

基　　金：浙江省康恩贝医院管理软科学研究项目(2011ZHA-KEB206);温州市科技局科研项目(Y20110255);温州医科大学附属眼视光医院院内课题(YNKT201202)

摘　　要：为解决基本医疗保险运行过程中出现的次均费用持续大幅增长、医保基金面临超支等问题,国内在许多城市如北京等多地开展总额预付试点改革工作,取得了一定的成效。澳大利亚则采用病例组合资金模型(DRGS),被世界上许多国家和地区所借鉴。总额预付制和DRGS两种机制各有利弊,通过对这两种机制的利弊分析与对比研究,期望为国内医疗保险制度改革有所借鉴、应用和启发。To solve the ever-increasing average cost of medical care, the over-expenditure of the medical insurance fund and so on, the Chinese government has carried out the total pre-service payment in many cities in China, such as Beijing. However, Australia chooses the diagnosis related groups mode which is called DRGS for short. It’s referred by many countries in the world. Because there are pros and cons for the two modes, I will make the comparison and demonstration for medical fund government compensation policy of China and diagnosis related groups mode . The investigation will be helpful for our country to get the analysis, reference, application and enlightenment from the current policy reform.

关 键 词：总额预付制 DRGS 医疗保险 补偿机制 

分 类 号：R197.1[医药卫生—卫生事业管理]