DRG/DIP体系下新医药技术的医保支付机制研究  

Research on Medical Insurance Payment Method of New Medical Technology Under DRG/DIP Payment System

作　　者：王芳旭 陶立波 

机构地区：[1]北京大学医学部卫生政策与技术评估中心,北京100191 [2]北京大学公共卫生学院卫生政策与管理学系,北京100191

出　　处：《中国医疗保险》2023年第2期40-44,共5页China Health Insurance

摘　　要：目的:探讨DRG/DIP体系下新医药技术的医保支付机制。方法:基于文献综述和理论研究,梳理总结国内外打包支付下新医药技术支付方式的经验,对我国DRG/DIP体系下医保支付政策设计进行分析。结果:国际上实施DRG支付的国家和地区在新医药技术初期多采用除外支付或设置新分组和费率的方法予以支付,积累充分信息后再将其纳入DRG一般支付体系。我国各地试点经验中的思路与国际经验基本一致,但具体制度流程尚比较模糊,有待进一步完善。结论:我国DRG/DIP体系下新医药技术的医保支付,应在评估筹资能力的基础上,借鉴典型国家和地区的经验,综合考虑短期和长期支付方法,从而对新医药技术给予合理支付。Objective: The paper attempts to explore the mechanism of medical insurance payment for new medical technology under DRG/DIP system. Methods: Based on literature review and theoretical research,the experience of new medical technology payment methods under package payment at home and abroad was summarized, and the design of medical insurance payment policy under DRG/DIP system was analyzed. Results:The countries and regions that implement DRG payment usually pay the new medical technology by exclusion payment or set new groups and rates at the initial stage of the new medical technology, and then incorporate it into the DRG general payment system after accumulating sufficient information. The idea of pilot experience in China is basically consistent with international experience, but the specific system and process is still fuzzy and needs to be improved. Conclusion: On the basis of evaluating the financing ability, we should learn from the experience of typical countries and regions and consider the short-term and long-term payment mechanism, so as to make a reasonable payment for the new medical technology under the DRG/DIP payment system.

关 键 词：疾病诊断相关分组 按病种分值付费 新医药技术 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]