疾病诊断相关分组的国内外研究进展及对策建议  

Research Progress and Countermeasures of Disease Diagnosis Related Groups at Home and Abroad

作　　者：潘莹 王敏 何祯 孟雪 杨磊[5] 邢明强 PAN Ying;WANG Min;HE Zhen;MENG Xue;YANG Lei;XING Ming-Qiang(Medical education collaboration and medical education research center,Hebei Medical University,Shijiazhuang 050051,China;Business School of Hebei Normal University,Shijiazhuang 050024,China;Journal of Hebei Medical University,Shijiazhuang 050051,China;Department of Infectious Disease,Shijiazhuang Fifth Hospital,Shijiazhuang 050024,China;School of public health,Hebei Medical University,Shijiazhuang 050051,China;Hebei Institute of Human Resources and Social Security,Shijiazhuang 050057,China)

机构地区：[1]河北医科大学医教协同与医学教育研究中心,石家庄050051 [2]河北师范大学商学院,石家庄050024 [3]河北医科大学期刊社,石家庄050051 [4]石家庄市第五医院感染一科,石家庄050024 [5]河北医科大学公共卫生学院,石家庄050051 [6]河北省人力资源社会保障科学研究所,石家庄050057

出　　处：《中国药物经济学》2022年第6期118-123,128,共7页China Journal of Pharmaceutical Economics

基　　金：河北省社会科学基金项目(HB17SH032)。

摘　　要：疾病诊断相关分组(DRGs)是医疗保险机构按照该病种的预付费标准向医院支付费用,而对于超出标准的医疗费用则由医疗服务机构本身承担的一种付费制度,被广泛证明在医疗保险支付时对控制不合理的医疗费用具有重要的现实意义。本文论述了我国DRGs相关政策背景,以及国内外DRGs的研究进展,发现各国应用DRGs付费制度在分配和管理医疗卫生资源方面取得了良好的效果,并阐述了单病种付费制度与DRGs的差异。根据DRGs在实施过程中面临的挑战,提出应明确政府在医疗付费改革中的主导地位;因地制宜,选择符合本地的病种,扩大试点范围;提高病案管理质量,促进信息系统建设;推动临床路径的推广和完善,形成全国统一的DRGs付费体系的系列建议。Disease diagnosis related groups(DRGs) is a payment system for medical insurance institutions to pay for hospitals according to the prepaid standard of the disease,and a payment system for medical expenses that exceeds the standard is borne by the medical service itself.It has been widely proved that it is of great practical significance to control unreasonable medical expenses in the payment of medical insurance.This paper reviews the policy background of DRGs in China and the research progress of DRGs at home and abroad.It is found that the application of DRGs payment system in countries has achieved good results in the allocation and management of medical and health resources,and the differences between single disease payment system and DRGs are described.According to the challenges faced by DRGs in the implementation process,it is recommended to clarify the government’s dominant position in the medical payment reform;adapt to local conditions,choose to comply with local diseases,expand the scope of the pilot;improve the quality of medical records management,promote the construction of information systems;promote the promotion and improvement of clinical pathways,form a unified national DRGs payment system.

关 键 词：疾病诊断相关分组 单病种付费 研究进展 

分 类 号：R956[医药卫生—药学]