医保总额控制下的DRG付费运行情况分析  

Analysis of DRGs Payment Operation under Total Payment Control

作　　者：汤有为[1] 陈海聪[1] 谢丽云[1] TANG You-wei;CHEN Hai-cong;XIE Li-yun(Taizhou Hospital of Zhejiang Province)

机构地区：[1]浙江省台州医院

出　　处：《医院管理论坛》2020年第7期15-16,共2页Hospital Management Forum

摘　　要：按诊断相关分组(Diagnosis Related Groups,DRGs)付费是国家医疗改革的重大举措,通过推行DRGs付费可以在一定程度上控制住院费用的增长,真正做到百姓能够住得起院。从医院角度来说,虽然,DRGs付费是推行收入结构调整,优化资源配置的重要机遇,但是,伴随着机遇的是费用超支和结算亏损引发的医院现金流风险。本文通过分析DRGs付费过程中存在的问题,分享采用DRGs付费以来医院减少亏损的管理经验,寻找一条保证在DRGs付费中,医院合理可持续发展的管理路径。Payment by Diagnosis Related Groups(DRGs)is a major measure of national medical reform,which can control the growth of hospitalization expenses to some degree and make the hospitalization affordable to the general public.From the perspective of the hospital,although DRGs payment is an important opportunity for carrying out income structure adjustment and optimizing resource allocation,it is also accompanied by the cash flow risk brought by cost overrun and settlement loss.This paper analyzed the problems in DRGs payment,shared the management experience of reducing losses,and explored a reasonable and sustainable management path of DRGs payment for the hospital.

关 键 词：DRGs付费 医疗保险 付费管理 运营分析 

分 类 号：R197.3[医药卫生—卫生事业管理]