上海市中医医院医保支付改革实践探索  

Practice and Exploration of Medical Insurance Payment Reform in Shanghai Municipal Hospital of Traditional Chinese Medicine

作　　者：王静[1] 钟力炜 言行 沈婷[1] 胡玉娇 毛俊华[1] Wang Jing;Zhong Liwei;Yan Xin(Shanghai Municipal Hospital of Traditional Chinese Medicine,Shanghai,200071,China;不详)

机构地区：[1]上海中医药大学附属上海市中医医院,上海200071

出　　处：《中国医院管理》2022年第3期70-73,共4页Chinese Hospital Management

摘　　要：疾病诊断相关分组(DRG)支付方式作为医保支付制度改革的重要举措,目前在全国范围内推行。2021年上海市中医医院确定为试点医院。医院通过DRG数据PDSA质控环建设,提高上传数据质量;建立新的管理模式,迎接DRG支付挑战;立足于医联体建设,探索DRG支付应用等多方面的实践探索。医院2021年1月—2021年9月病史上报率达到100%,核心数据质控通过率达到100%,2021年1月—2021年8月稳定组DRG支付率为101.74%。医院病种支付补偿率明显提高,医院运营状况得到明显改善。As an important measure of the medical insurance payment reform,the diagnosis related group(DRG)payment is currently being implemented nationwide.In 2021,Shanghai Municipal Hospital of Traditional Chinese Medicine was designated as the pilot hospitals.The hospital improves the quality of uploaded data through the construction of the DRG data PDSA quality control loop;establishes a new management model to meet the challenge of DRG payment;research the application of DRG payment in the medical consortium mode.The medical cases reporting rate reached 100%from January 2021 to September 2021,the core data quality control pass rate reached to100%,and the DRG payment rate for the stable group was 101.74%from January 2021 to August 2021.The compensation rate of hospital diseases payment was significantly improved and the operating conditions of hospital were significantly improved.

关 键 词：疾病诊断相关分组 基本医疗保险 支付方式 改革 精细化管理 

分 类 号：R197.1[医药卫生—卫生事业管理]