云南省医疗机构DRGs-PPS支付改革试点效果分析  

Analysis of DRGs -PPS Payment Reform in Medical Institutions in Yunnan

作　　者：李雅琳 熊蔓 陆烨 高华斌[2] LI Yalin;XIONG Man;LU Ye(College of Humanity and Management ,Kunming Medical University,Kunming,Yunnan,650500,China)

机构地区：[1]昆明医科大学人文与管理学院,云南昆明650500 [2]昆明医科大学第一附属医院,云南昆明650500

出　　处：《中国卫生质量管理》2019年第5期52-56,共5页Chinese Health Quality Management

基　　金：云南省教育厅科学研究基金项目《DRGs与医院内部控费动力的研究》(2018JS174)研究成果;昆明医科大学“十三五”重点培育扶持学科“社会保障”建设研究成果

摘　　要：目的研究云南省医疗机构DRGs-PPS支付改革成效和面临问题,为更好地推广DRGs-PPS支付提出建议.方法以2017年云南省6家DRGs-PPS试点医疗机构为研究对象,借助云南省DRGs绩效管理网络平台,对16257份数据进行统计分析.结果 DRGs支付与权重高度正相关,医院结余与实际医疗费用总额、人均自付费用、平均住院日负相关.结论云南省DRGs-PPS支付改革坚持总控原则并配合按项目付费,促进医院主动降低医疗费用,明确职能定位,提高诊疗水平,DRGs-PPS支付的进一步推广需加强部门间配合,尽快统一编码,规范病案首页书写和推行临床诊疗路径管理.ObjectiveTo study the effectiveness and problems of DRGs-PPS payment reform in medical institutions in Yunnan, and to provide suggestions for better promotion of DRGs-PPS.MethodsTaking six medical institutions as participants, 16 257 data from DRGs performance management network platform in 2017 were analyzed and compared. ResultsDRGs payment was highly positively correlated with the weight, hospital balance was negatively correlated with total actual medical expenses, total per capita self-payment and average hospitalization stays. Conclusion The DRGs-PPS payment reform in Yunnan adhered to the principle of general control and cooperated with project-based payment, so as to promote hospitals to take the initiative to reduce medical costs, clarify their functions and improve the level of diagnosis and treatment. Further promotion of DRGs-PPS payment needed to strengthen inter-part cooperation, unify encoder as soon as possible, standardize front page writing of medical records and clinical pathways.

关 键 词：医疗保险 支付方式 DRGs-PPS支付 

分 类 号：R197.1[医药卫生—卫生事业管理]