DIP与临床路径对医疗资源消耗影响的实证研究  

An Empirical Study On The Impact Of DIP And Clinical Pathway On Medical Resource Consumption

作　　者：陈维雄[1] 林雯琦 欧凡[1] 陈泽波[1] Chen Weixiong;Lin Wenqi;Ou Fan;Chen Zebo(Guangdong Provincial People's Hospital,Guangzhou,510000;Guangdong Pharmaceutical University,Guangzhou,510006)

机构地区：[1]广东省人民医院,广州510000 [2]广东药科大学,广州510006

出　　处：《中国医疗保险》2021年第3期56-61,共6页China Health Insurance

摘　　要：目的:探究按病种分值付费与临床路径管理对医疗资源消耗的影响,为医院内控及政策优化提供参考。方法:选取6个常见病种的病例,并从"是否参加广州医保"或"是否入组临床路径"两个纬度分类汇总,将其中"入组的广州医保病例"(联合应用组)、"未入组的广州医保病例"(DIP组)、"入组的异地医保病例"(临床路径组)等三组病例纳入研究,比较资源消耗指标和医保支付情况的差异。结果:临床路径组在降低资源消耗、平衡医保基金上的作用效果不如联合应用组和DIP组;联合应用组在减少变异上具有优势,但在部分病种的控费效果上不如DIP组。结论:应积极探索临床路径与医保支付方式的平衡机制,达到"1+1>2"的政策联动效果。Objective:To explore the impact of DRG payment and clinical pathway management on medical resource consumption,and to provide reference for hospital internal control and policy optimization.Methods:In this paper,six cases of common diseases were selected and classifi ed from two dimensions,whether to participate in Guangzhou medical insurance or whether to be included in clinical pathway.Three groups of cases were included in the study,including Guangzhou medical insurance cases(combined application group),non Guangzhou medical insurance cases(DIP group)and medical insurance cases in diff erent places(clinical pathway group).The diff erences of resource consumption index and medical insurance payment were compared.Results:The eff ect of clinical pathway group in reducing resource consumption and balancing medical insurance fund is not as good as the combined application group and DIP group.The combined application group has advantages in reducing variation,but the cost control eff ect of some diseases is not as good as DIP group.Conclusion:We should actively explore the balance mechanism between clinical pathway and medical insurance payment mode to achieve the policy linkage eff ect of 1+1>2.

关 键 词：医保支付方式 按病种分值付费 临床路径 精细化管理 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]