DRG医保支付方式下的医院伦理困境及对策研究  

Research on Hospital Ethical Dilemmas and Countermeasures under DRG Healthcare Payment System

作　　者：卢钰 朱与菁 钟欣益 LU Yu;ZHU Yujing;ZHONG Xinyi(School of Marxism,Suzhou City University,Suzhou 215104,China;Institute for Hospital Management,Tsinghua University,Shenzhen 518055,China;Medical Insurance Office,Suzhou Municipal Hospital(North District),Suzhou 215008,China)

机构地区：[1]苏州城市学院马克思主义学院,江苏苏州215104 [2]清华大学医院管理研究院,广东深圳518055 [3]苏州市立医院(北区)医保办,江苏苏州215008

出　　处：《医学与哲学》2024年第12期25-28,共4页Medicine and Philosophy

基　　金：2019年上海申康医院发展中心管理研究项目(2019SKMR-15)。

摘　　要：DRG医保支付方式已成为国内主流的医疗服务给付的方式之一,然而许多公立医院在实践过程中未能很好地适应改革,从医学伦理视角对DRG运行中的伦理困境及其原因进行深入剖析,首先指出当下医疗机构可能面临的实际问题,如医疗行为异化、挑选患者、费用转移与新技术博弈等,分析了驱动医疗行为的内在因素,然后回归支付方式改革本源——价值医疗思想,建议管理者通过提升价值认同、改善工作氛围、建立科学考评机制、兼顾药耗协同等措施推进医院高质量发展。Diagnosis related group(DRG)healthcare payment system has become one of the mainstream medical insurance payment methods in China.However,many public hospitals have struggled to adapt well to the reform in practice.This article deeply analyzes the ethical dilemmas and reasons in the operation of DRG from the perspective of medical ethics.Firstly,this paper points out the practical problems that medical institutions may face at present,such as medical behavior alienation,patient selection,cost transfer,and new technology game,analyzes the internal factors driving medical behavior.Then,it advocates a return to the core principle of payment system reform—value-based healthcare.It suggests that managers promote high-quality development of hospitals by enhancing value recognition,improving working atmosphere,establishing scientific evaluation mechanisms,and balancing medicine and consumption coordination.

关 键 词：医保改革 支付方式 伦理困境 

分 类 号：R-05[医药卫生]