DRGs用于医疗费用控制的研究进展  

Research Progress of DRGs Used in Medical Expenses Control

作　　者：张灿宏 田秀丽[2] 王琨[2,3] 井国兰 ZHANG Canhong;TIAN Xiuli;WANG Kun;JING Guolan(Branch Office of Tai'an Central Hospital,Tai'an,Shandong Province,271000 China;Department of Nursing,Taishan Vocational College of Nursing,Tai'an,Shandong Province,271000 China;Department of Medical Insurance Management,Tai'an Central Hospital,Tai'an,Shandong Province,271000 China)

机构地区：[1]泰安市中心医院分院院办,山东泰安271000 [2]泰山护理职业学院护理系,山东泰安271000 [3]泰安市中心医院医疗保险管理科,山东泰安271000

出　　处：《中国卫生产业》2021年第5期195-198,共4页China Health Industry

基　　金：山东省人文社会科学课题(2020-NDFX-24);泰安市社会科学课题(20-ZD-055);泰安市哲学社会科学规划研究项目(2020skx113)。

摘　　要：在确保医疗质量的前提下有效控制医疗费用支出是目前世界性医疗管理难题,也是我们国家高度重视的医改难题。疾病诊断相关分组是一种基于疾病分类的管理类技术工具,有助于医疗服务绩效及费用控制的评价研究。疾病诊断相关分组预付费模式倒逼医院积极控制成本费用,可促使医院细化住院服务成本管理,可有效控制医疗费用不合理增长,进而促进医疗卫生工作重心由“以治病为中心”向“以健康为中心”转变,是国家医改的重点举措,也是提升医院管理水平、降能增效的根本手段,有利于提高医疗质量,节约医保基金,减轻群众负担。该文分析了疾病诊断相关分组在国内、外的发展历程、实施效果、研究进展以及对医疗费用控制的影响,探讨疾病诊断相关分组预付费模式在我国医疗卫生和医疗保险中的应用现状和面临问题,为控制不合理费用支出,提高医院管理效率提供新途径。Effectively controlling medical expenditures under the premise of ensuring medical quality is a worldwide medical management problem,and it is also a medical reform problem that our country attaches great importance to.Disease diagnosis related grouping is a management technical tool based on disease classification,which is helpful for the evaluation and research of medical service performance and cost control.The pre-paid model of disease diagnosis-related grouping forces hospitals to actively control costs,which can prompt hospitals to refine in-patient service cost management,which can effectively control unreasonable growth in medical expenses,and promote the focus of medical and health work from"treatment-centered"to"health-centered"transformation,which is a key measure of the national medical reform,and it is also a fundamental means to improve hospital management,reduce energy consumption and increase efficiency.It is conducive to improving medical quality,saving medical insurance funds,and reducing the burden on the masses.This article analyzes the development history,implementation effects,research progress,and impact of disease diagnosis-related groupings at home and abroad,as well as the impact on medical expense control,and discusses the application status and problems of disease diagnosis-related grouping prepaid models in our country's medical health and medical insurance,which provides a new way to control unreasonable expenses and improve hospital management efficiency.

关 键 词：疾病诊断相关分组 医疗费用 医疗保险预付费制度 

分 类 号：R197[医药卫生—卫生事业管理]