DRG/DIP支付方式改革成效量化分析——以监测点和代表地市为例  

Quantitative Analysis of the Effects of DRG/DIP Payment Method Reform——Taking Monitoring Sites and Representative Cities as Examples

作　　者：周梦强 崔婧祎 王军 刘喜恩 吴及[2,3] 

机构地区：[1]北京惠及智医科技有限公司,北京100193 [2]清华大学电子工程系,北京100084 [3]清华大学人工智能学院,北京100084

出　　处：《中国医疗保险》2024年第7期68-75,共8页China Health Insurance

基　　金：科技创新2030-“新一代人工智能”重大项目“标准化儿童患者模型关键技术与应用”(2021ZD0113402)。

摘　　要：目的:量化评估DRG/DIP支付方式改革对医疗服务效能和医疗费用管理的影响。方法:基于邯郸、上饶、邵阳和东营四个监测点的医保结算数据以及南京、大同、安阳和宿迁等代表城市的医疗全病历数据,进行描述性统计分析。结果:在医疗服务效能方面,CMI平均提升0.1,平均住院日和CMI标化次均住院日分别下降0.7日和0.9日;在医疗费用管理方面,次均住院费用平均下降3.24%,且费用结构趋向更加合理,药品、耗材占比有所下降,医疗服务费用占比逐步提升。医疗机构整体达到医保基金收支平衡,不同科室有所差异。结论:DRG/DIP支付方式改革对医疗机构的服务效能和费用管理均有所改善。建议强化医疗机构在按病组付费模式下的全局统筹管理模式,提高整体运营效益。Objective:The paper attempts to quantitatively evaluate the impact of DRG/DIP payment method reform on medical service efficiency and medical cost management.Methods:Based on the medical insurance settlement data from four monitoring sites of Handan,Shangrao,Shaoyang and Dongying,as well as comprehensive medical record data from representative cities such as Nanjing,Datong,Anyang and Suqian,descriptive statistical analysis was conducted.Results:In terms of medical service efficiency,the average CMI increased by 0.1,the average length of stay(ALOS)and the CMI-standardized ALOS decreased by 0.7 days and 0.9 days,respectively.Regarding medical cost management,the average hospitalization cost decreased by 3.24%,and the cost structure became more reasonable,with a decrease in the proportion of drug and consumable costs and a gradual increase in the proportion of medical service costs.Medical institutions have achieved an overall balance in medical insurance fund revenue and expenditure,though there were differences among various departments.Conclusion:The DRG/DIP payment method reform has improved both the service efficiency and cost management of medical institutions.It is recommended to strengthen the overall coordination management model of medical institutions under the disease group payment model to improve overall operational efficiency.

关 键 词：医保基金 DRG/DIP支付改革 医疗服务效能 医疗费用管理 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]