以医疗质量为基础的DRG核心要素调整机制研究  

Study on the Adjustment Mechanism for the Core Elements of DRG Payment based on Medical Quality

作　　者：郑丽敏[1] 陈新平[2] 林镇江 ZHENG Limin;CHEN Xinping;LIN Zhenjiang(Nanping First Hospital,Nanping Fujian 353006,China;不详)

机构地区：[1]福建省南平市第一医院,福建南平353006 [2]福建省肿瘤医院,福建福州350014

出　　处：《卫生经济研究》2023年第8期33-36,共4页

基　　金：福建省医疗保障研究院课题“福建省DRG医保支付结算研究”(2022C02)。

摘　　要：以福建省南平市第一医院具体病例DRG结算情况为例,分析DRG核心要素变动引起的医保支付结算差异,认为主要诊断及编码、临床路径、新技术运用、诊疗行为、药品耗材集中采购等要素变动均会影响DRG支付结果。对此,需要建立以医疗质量为基础的DRG核心要素调整机制:加强监管,完善临床路径,探索建立新技术支付制度,推进诊疗行为与医疗费用协同,建立医保支付方式改革与其他医改政策协同机制。Taking the DRG payment settlement in Nanping First Hospital in Fujian Province as an example,this article analyzes the differences in medical insurance payment settlement caused by changes in core elements of DRG payment,and finds that the changes in major diagnosis and coding,clinical pathway,application of new technology,diagnosis and treatment behavior,centralized procurement of drug and consumables will affect DRG payment results.In this regard,it is necessary to establish an adjustment mechanism for the core elements of DRG payment based on medical quality,strengthen supervision,improve the clinical pathway,explore a new technology payment system,promote the collaboration between diagnosis and treatment behavior and medical expenses,and establish a collaborative mechanism between the reform of medical insurance payment methods and other medical reform policies.

关 键 词：DRG支付 医疗质量 核心要素 调整机制 

分 类 号：F840.684[经济管理—保险]