国家医疗保障疾病诊断相关分组(CHS-DRG)制定与实施的关键环节探讨  

Discussion On Key Links of CHS-DRG Formulation and Implementation

作　　者：崔斌[1] 朱兆芳 Cui Bin;Zhu Zhaofang(School of Public Health,Peking University,Beijing,100191;Health Development Research Center of National Health Commission,Beijing,100044)

机构地区：[1]北京大学公共卫生学院卫生政策与管理学系,北京100191 [2]国家卫生健康委卫生发展研究中心,北京100044

出　　处：《中国医疗保险》2021年第5期47-51,共5页China Health Insurance

摘　　要：国家医疗保障疾病诊断相关分组(CHS-DRG)是国内第一部国家级的以实现医保DRG付费为目标编制的DRG,其目的是实现“医-保-患”三方共赢。实施CHS-DRG付费包括数据采集和质量控制、DRG分组与细化、相对权重计算与调整、费率与付费标准测算、结算细则制定与实施、监管考核与评价等6个关键技术环节。在CHS-DRG试点前期,要重点做好充实DRG人才队伍、确保技术规范落地、实现数据标准对接、完善DRG结算流程、完成信息系统改造、建立监管考核机制等工作,为逐步将CHS-DRG打造成医保支付领域的“通用语言”奠定坚实的基础。China Healthcare Security Diagnosis Related Groups(CHS-DRG)is the fi rst national DRG that purposively designed for medical insurance payment.It aims to achieve tripartite wins among medical insurance,hospitals and patients.There are six important technical links in CHS-DRG implementation,including data collection and quality control,DRG grouping and refi nement,related weight calculating and adjustment,payment rate estimating,settlement rules design,and supervision assessment and evaluation.The key work points during pilot stage are to enrich DRG talent team,implement technical specifi cations,realize data standard docking,perfect settlement process,complete the transformation of information system and establish supervision and assessment mechanism,which will lay a solid foundation for building CHS-DRG into a common language in the field of medical insurance payment.

关 键 词：疾病诊断相关分组 DRG分组规范 支付方式改革 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]