某市DRGs与按病种分值付费双轨融合付费制度改革探索与实践  

Exploration and Practice of DRGs and the Dual-track Integration Payment System for Disease Classification Points in a City

作　　者：梁力中 李春梅 刘华锋 朱丽云 LIANG Li-zhong;LI Chun-mei;LIU Hua-feng;ZHU Li-yun(Affiliated Hospital of Guangdong Medical University,Zhanjiang,Guangdong 524001,China;Guangdong University of Medical Sciences,Zhanjiang,Guangdong 524023,China)

机构地区：[1]广东医科大学附属医院,广东省湛江市524001 [2]广东医科大学,广东省湛江市524023

出　　处：《现代医院管理》2020年第5期17-20,共4页Modern Hospital Management

基　　金：广东省科技厅应用型科技研发专项“创新湛江模式‘基于大数据云平台五位一体三医联动智慧医保体系的建设与营运’”(2015B010131016);广东省财政厅2020年科研课题“三级公立医院绩效考核评价体系精细化管理对策研究”(20S141)。

摘　　要：为切实保障参保人的医疗保险权益,合理控制住院医疗费用,进一步完善基本医疗保险支付制度,有效推进分级诊疗政策的落实,某市开展DRGs与按病种分值融合的付费制度改革的探索。将市内各级医院分为A类与非A类医院两大类别,对于病案质量较好的A类医院采用DRGs后CMI系数与主要诊断对应分值的乘积计算分值,对于非A类医院采用不同级别收治不同档次病种,以“收治能力范围内,同病同治同付费,能力不符跨级收治打折付费”的原则建立了同病同治同付费的公平与效率机制,是通过付费制度改革落实分级诊疗的有益尝试。In order to effectively protect the insured’s medical insurance rights and interests,reasonably control the hospitalization expenses,further improve the basic medical insurance payment system,and effectively promote the implementation of the hierarchical medical policy,a city has carried out exploration on the reform of the payment system integrating DRGs and classification points.All levels of hospitals in the city are divided into hospitals of class A and non-class A.For class A hospitals with good medical record quality,the score is calculated by multiplying the CMI coefficient and the score corresponding to the main diagnosis.For non-class A hospitals,the score is calculated by using different levels of treatment and different grades of diseases.A fair and efficient mechanism for the same disease with the same treatment and the same payment is established in accordance with the principle of“within the range of admission capacity,the same disease with the same treatment and payment;beyond the admission ability,discount payment for cross-class admission and treatment”,which is a beneficial attempt to implement the graded diagnosis and treatment through the reform of payment system.

关 键 词：病种分值 DRGS 付费制度 改革 

分 类 号：R197[医药卫生—卫生事业管理]