基于创新扩散理论视角的DRG和DIP支付方式探讨  

DRG and DIP payment methods: from the perspective of Diffusion of Innovations Theory

作　　者：张霄艳[1] 陈欣[1] Zhang Xiaoyan;Chen Xin(Hubei University School of Public Administration,Wuhan 430062,Hubei Province,China)

机构地区：[1]湖北大学公共管理学院,武汉430062

出　　处：《中国医疗管理科学》2022年第3期37-41,共5页Chinese Journal Of Medical Management Sciences

基　　金：湖北省校级大学生创新创业训练项目“健康中国战略下我国医保经办服务绩效考核及激励约束机制研究”(X202010512025)。

摘　　要：医保支付方式改革是推动医保高质量发展的重要组成部分,对规范医疗机构的医疗行为和控制医疗费用具有引导作用。基于创新扩散理论的视角,从相对优越性、兼容性、复杂性、可试性和可观察性5个维度对疾病诊断相关分组(DRG)和基于大数据的病种组合(DIP)进行辨析。研究发现,DRG虽然在激励医院控制自身成本、提高医疗服务效率等方面表现出了优越性,但在数据质量、管理和技术水平方面要求较高,操作难度大。DIP作为中国本土化的一种支付方式,其受信息化等的技术要求约束小,更加符合我国的临床实践,但后付费制的特点又决定了其在诱导需求、医疗资源浪费等方面引发的问题。无论是DRG还是DIP,其目的都在于整合各种资源,实现对医保资金的有效分配。The reform on medical insurance payment methods is essential for promoting the high-quality development of medical insurance and plays an important role in regulating the health care behavior of medical institutions and controlling medical expenses. From the perspective of Diffusion of Innovations Theory(DIT), the Diagnostic Related Grouping(DRG) and Big Data Diagnosis-Intervention Packet(DIP) were analyzed in flve dimensions: relative superiority, compatibility, complexity, testability, and observability. It has been found that although DRG has shown advantages in motivating hospitals to control their own expenditures and improve the efficiency of medical services, it has high requirements on data quality, management, and technology and is difficult in practice. As a localized payment method in China, DIP has less technical requirements for informatization and is more in line with clinical practice in China. However, as a post-payment system, DIP also has weakness such as inducing demand and wasting medical resources. Both DRG and DIP are designed to integrate various resources and realize the effective allocation of medical insurance funds.

关 键 词：创新扩散 支付方式 DRG DIP 

分 类 号：R197[医药卫生—卫生事业管理]