CHS-DRG付费模式下肿瘤相关特殊病例分析与应对策略  

Analysis and Coping Strategies of Tumor-related Special Cases under the CHS-DRG Payment Model

作　　者：田羿[1] 孙维帅 柳俊杰[1] 张琪[1] 郑金坡 郭思柔 TIAN Yi;SUN Weishuai;LIU Junjie;ZHANG Qi;ZHENG Jinpo;GUO Sirou(Tianjin Medical University Cancer Hospital,Tianjin,300060 China)

机构地区：[1]天津医科大学肿瘤医院,天津300060

出　　处：《中国卫生产业》2022年第8期161-164,共4页China Health Industry

摘　　要：医保基金按照病例所进入的诊断相关组的付费标准支付给医疗机构,不再按照实际费用支付,医保基金支付金额等于DRG组支付标准减患者自负金额。医保支付方式改革对医疗机构精细化、标准化的要求越来越高,医疗机构应当尽快适应改革,规范诊疗行为、控制医疗成本、保证医疗质量。通过对CHS-DRG支付模式下肿瘤相关未入组病例、高倍病例、低倍病例、特病单议和个人负担高于支付标准等病例的相关政策要求和形成原因进行总结和分析,提出了医院的应对措施,为医院适应DRG支付方式改革,取得更高质量发展提供借鉴。Medical insurance funds are paid to medical institutions according to the payment standard of the diagnosis-related group entered by the case,and are no longer paid according to the actual cost.The payment amount of the medical insurance fund is equal to the payment standard of the DRG group minus the patient's self-paying amount.The reform of medical insurance payment methods has higher and higher requirements for the refinement and standardization of medical institutions.Medical institutions should adapt to the reform as soon as possible,standardize diagnosis and treatment behavior,control medical costs,and ensure medical quality.By summarizing and analyzing the relevant policy requirements and causes of cases such as tumor-related ungrouped cases,high-frequency cases,low-frequency cases,special disease cases and personal burdens,and cases higher than the payment standard under the CHS-DRG payment model,and the countermeasures of the hospital are put forward to provide reference for the hospital to adapt to the reform of DRG payment method and achieve higher quality development.

关 键 词：DRG付费 特殊病例 应对策略 

分 类 号：R73-71[医药卫生—肿瘤]