DRG支付方式带给中国医疗服务体系发展的机遇与挑战分析  

Analysis of opportunities and challenges brought to the development of China's medical service system by DRG payment

作　　者：于保荣[1] YU Baorong(School of Insurance and Economics,University of International Business and Economics,Beijing 100029,China)

机构地区：[1]对外经济贸易大学保险学院,北京100029

出　　处：《卫生软科学》2024年第9期74-78,共5页Soft Science of Health

摘　　要：DRG支付方式是中国医疗服务体系高质量发展的机遇,体现在DRG是促进医疗管理和绩效管理升级的有效工具,DRG支付方式改革将促进医院病案质量的提升、促进合理用药和临床药学的发展、推动医用耗材的精细化管理、促进检验与临床诊疗的更好结合及医疗服务效率的提高、医疗服务体系的重塑。同时,DRG的科学设置与执行能力、门诊统筹的建立对医保支付管理的要求、基层医务人员的素质对建立基层首诊与转诊制度的阻碍、门诊共济制度下的基层与医院门诊服务支付方式等问题,是对支付方式改革和中国医疗服务体系的挑战。中国医疗服务提供体系未来的变化趋势为三级医疗机构规模的压缩和基层社区守门人制度的建立,影响改革的重要因素之一是医疗服务价格机制改革。DRG payment is an opportunity for the high-quality development of China's medical service system,which is reflected in the fact that DRG is an effective tool to promote the medical management and performance management.The reform of DRG payment promotes the quality of hospital medical records,promotes the development of rational drug use and clinical pharmacy,promotes the fine management of medical consumables,promotes the better integration of medical laboratory science and clinical treatment,improves the medical service efficiency and reshapes medical service system.Meanwhile,issues such as the scientific setting and implementation ability of DRG,the requirements of the outpatient reimbursement for the management of medical insurance payment,the obstacles of the quality of primary health workers to the establishment of the primary consultation and referral system,and the payment methods of outpatient services in primary health care institutions and hospitals under the mutual-aid mechanism for covering outpatient bills are challenges to the reform of payment methods and China's medical service system.The future trend of China's health care delivery system is scale reducing of tertiary hospitals and establishment of the gatekeeper system in the community.One of the important factors affecting the reform is the reform of the medical service pricing mechanism.

关 键 词：支付方式改革 医疗服务体系 机遇和挑战 门诊共济制度 社区医生守门人制度 

分 类 号：R194[医药卫生—卫生事业管理] F840.684[医药卫生—公共卫生与预防医学]