DRG支付制度中低码高编行为实证分析研究  

Empirical Analysis of Upcoding Behavior in DRG Payment

作　　者：程文炜 常维夫[1] 

机构地区：[1]中南大学湘雅三医院医务部,长沙410013

出　　处：《中国医疗保险》2022年第9期11-15,共5页China Health Insurance

基　　金：湖南省自然科学基金项目(2022JJ40734);湖南省教育厅科学研究项目(20K138)。

摘　　要：以我国某DRG付费制度改革试点城市为研究样本,实证分析DRG支付制度实施前后相同ADRG组下各DRG组的病例数及构成比变化情况,选择DRG支付制度实施后病例数出现较大增长且伴有严重合并症或并发症的DRG组进行中断时间序列分析。结果显示试点城市医院存在低码高编行为。低码高编是DRG支付制度改革中的重点管控方向,可以通过加强病案首页质控以及诊断编码的培训学习等方式防范和降低低码高编道德风险,保障DRG支付制度良性运转。Taking a DRG payment system reform pilot city in China as a research sample,we empirically analyzed the changes in the number of cases and the composition ratio of each DRG group under the same ADRG group before and after the implementation of DRG.Interrupted time series analysis was performed in the DRG group with severe comorbidities or complications.The results showed that there were upcoding behaviors in hospitals of the pilot city,which must be regulated.We can strengthen the training and learning of medical record and diagnostic coding,and ensure the healthy operation of DRG.

关 键 词：DRG支付制度 低码高编 医保监管 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]