我国DRG支付方式改革问题与对策探讨  

Challenges and countermeasures in China's DRG payment reform

作　　者：李可望 孟晓微 王婷 顾霞[1] 王怡鑫[1] 唐敏 邱令璐 LI Kewang;MENG Xiaowei;WANG Ting;GU Xia;WANG Yixin;TANG Min;QIU Linglu(Sichuan Cancer Hospital,Chengdu,Sichuan Province,610041,PRC)

机构地区：[1]四川省肿瘤医院,四川省成都市610041

出　　处：《中国医院》2024年第9期1-6,共6页Chinese Hospitals

基　　金：国家自然科学基金委员会面上项目(82274142);四川省科学技术厅重点研发项目(2019YFS0031)。

摘　　要：目的:梳理和探讨DRG支付方式改革现存问题,为医院探索和实施改革提供参考依据,以期加快推动DRG支付方式改革。方法:采用文献分析法对问题进行梳理,结合社会网络分析法对问题网络进行可视化解读和中心度分析,运用TOPSIS法对问题的中心度测量结果进行综合评价,找出DRG支付方式改革的核心问题。结果:DRG支付方式改革在推行中存在相关政策支持不足、临床对DRG改革认知不足和高编高套等问题;通过TOPSIS综合排序,排在前列问题分别是信息化水平不足(Ci=1.000)、绩效考核机制不健全(Ci=0.882)、病案首页质量有待提升(Ci=0.399)和临床路径管理不规范(Ci=0.385)。结论:医院应搭建信息管控平台,完善绩效考核机制,夯实病案首页质量,规范临床路径管理,进一步推动DRG支付方式改革有效实施。Objective:To identify and analyze the challenges in DRG payment reform and provide reference for hospitals to explore and implement reform,with the aim of accelerating the reform process.Methods:The study used literature analysis to identify issues and employed social network analysis to visualize and analyze the centrality of these issues.The TOPSIS method was applied to evaluate the centrality of problems,identifying the core issues in DRG payment reform.Results:Key issues in the implementation of DRG payment reform include insufficient policy support,lack of clinical understanding of DRG reform,and high coding and packaging rates.The top issues identified by TOPSIS were insufficient informatization(Ci=1.000),incomplete performance evaluation mechanisms(Ci=0.882),poor quality of medical record front pages(Ci=0.399),and non-standard clinical pathway management(Ci=0.385).Conclusion:Hospitals should establish information management platforms,improve performance evaluation mechanisms,enhance the quality of medical record front pages,and standardize clinical pathway management to further promote the effective implementation of DRG payment reform.

关 键 词：DRG支付 支付方式 医保支付 社会网络分析 TOPSIS法 

分 类 号：R197.3[医药卫生—卫生事业管理]