福建省某市实施C-DRG收付费制度对主要利益相关方的影响研究  

Research on Influence of C-DRG Pricing and Payment System on Main Stakeholders in a City of Fujian Province

作　　者：孟朝琳 蔡源益[2] 李志远 吴华章[2] MENG Zhaolin(School of Nursing,Capital Medical University,Beijing,100069,China)

机构地区：[1]首都医科大学护理学院,北京100069 [2]中国医科大学人文社科学院,辽宁沈阳110122

出　　处：《医学与社会》2022年第5期86-89,共4页Medicine and Society

基　　金：国家自然科学基金资助项目,编号72104154;辽宁省高等学校基本科研项目(人文社科类),编号为LZDR201701。

摘　　要：目的:分析福建省某市实施的C-DRG收付费制度对主要利益相关方产生的积极影响和非预期影响,为决策者提供参考依据。方法:选取福建省某市C-DRG的主要利益相关方进行半结构化访谈,采用类属分析法对访谈内容进行分析。结果:共访谈4名医疗机构管理人员、10名临床一线医生、8名患者以及2名医疗保险机构管理人员。实施C-DRG带来的积极影响包括减少不合理和不必要的诊断和治疗项目、改善医院内部运营管理和改进医保信息化建设及监管水平,但实施C-DRG也在一定程度上可能存在对重症患者补偿不足、诊疗不足及个别诊断升级行为等非预期影响。结论:C-DRG对主要利益相关方产生了一些积极影响的同时,也存在一些非预期影响,在重症患者补偿机制、质量保障机制以及监管机制方面有待进一步完善。Objective: To analyze the positive and unintended impacts of C-DRG pricing and payment system in a city of Fujian province on main stakeholders, so as to provide references for policymakers. Methods: The main stakeholders of C-DRG in a city of Fujian province were selected to conduct semi-structured interviews, and the interviews were analyzed by the theme analysis. Results: The interviews were conducted in 4 managers in hospitals, 10 clinical doctors, 8 patients and 2 managers in health insurance organization. The positive effects included that unnecessary diagnostic and therapeutic procedures were reduced, the internal operations of hospitals were strengthened and the capacities of information construction and supervision of medical insurance were improved. The unintended effects included inadequate reimbursement for patients with critical disease, the risks of insufficient diagnosis and treatment and the existence of diagnosis upgrade. Conclusion: C-DRG can produced both the positive effects and unintended consequences for main stakeholders. It is recommended to improve reimbursement mechanisms for patients with critical diseases, quality assurance mechanisms and supervision mechanisms.

关 键 词：疾病诊断相关分组 收付费制度 利益相关方 

分 类 号：R197[医药卫生—卫生事业管理]