总额预算下的DRG支付推动三明从治病向健康转型的案例分析  

Case study on Sanming′s transformation from medical treatment to health promotion through DRG payment under global budget

作　　者：王虎峰[1] 马彧 谢世堂 郭胜鹏 Wang Hufeng;Ma Yu;Xie Shitang;Guo Shengpeng(Public Health&Disease Control and Prevention,Renmin University of China,Beijing 100872,China;School of Public Administration and Policy,Health Reform and Development Center,Renmin University of China,Beijing 100872,China;Operation Management Office,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]中国人民大学公共健康与疾病预防控制交叉学科重大创新平台,北京100872 [2]中国人民大学公共管理学院/医改研究中心,北京100872 [3]首都医科大学附属北京天坛医院运营管理办公室,北京100070

出　　处：《中华医院管理杂志》2024年第7期500-504,共5页Chinese Journal of Hospital Administration

基　　金：国家社会科学基金重大项目(22ZDA096)。

摘　　要：医保支付方式改革是三明市"治未病、大健康"阶段实现全民健康的重要举措之一。本研究基于三明案例探讨总额预算下DRG支付方式的设计与实施,从而推动从治病向健康的转型。三明市的转型实践涉及理念重塑、结构重构、功能再造3个方面,从目标、路径、方法3个维度推动,并取得了明显成效。作者提出3条建议,包括坚持并完善总额预算下的DRG支付,重视医疗质量考核监控,以及设计适应各健康场景的"总额预算+"复合支付方式。The reform of medical insurance payment methods is one of the important measures for Sanming City to achieve universal health.This study explored the design and implementation of DRG payment method under global budget based on the case of Sanming,in order to promote the transformation from disease treatment to health promotion.The transformation practice of Sanming City involved three aspects:concept reshaping,structural reconstruction,and functional reconstruction,which were promoted from the dimensions of goals,paths,and methods,and have achieved significant results.The author proposed three recommendations,including adhering to and improving DRG payments under global budget,attaching importance to medical quality assessment and monitoring,and designing a global budget plus composite payment method that is suitable for various health scenarios.

关 键 词：健康 医疗保险 医保支付方式 疾病诊断相关分组 总额预算 三明医改 

分 类 号：R197.1[医药卫生—卫生事业管理]