DRG医保支付改革背景下的医院医保管理实践探索  

Practical Exploration on Hospital Medical Insurance Management under the Background of DRG Medical Insurance Payment Reform

作　　者：吕晓玲 杨坚 LV Xiaoling;YANG Jian(Wuhan Concorde Jiangbei Hospital and Caidian District People's Hospital,Wuhan,430100,China;不详)

机构地区：[1]武汉市协和江北医院暨蔡甸区人民医院,湖北武汉430100 [2]淮安市第二人民医院,江苏淮安223022

出　　处：《中国社会医学杂志》2024年第5期519-522,共4页Chinese Journal of Social Medicine

基　　金：江苏省医院协会管理创新研究课题(JSYGY-3-2023-208)。

摘　　要：目的探讨在深化医疗制度改革背景下,实施按疾病诊断相关分组(diagnosis related groups,DRG)付费制度对医院医保管理效率的影响。方法收集武汉市协和江北医院暨蔡甸区人民医院医保统计报表数据,对医院实施DRG支付制度管理进行具体的调研,分析DRG支付制度带来的医保管理成效及对医院服务能力的影响。结果至2022年,该院DRG支付制度改革获得成效,DRG控制情况较好,医保年度结余385.62万元,实现年度持续同比增长,职工DRG绩效收入占比整体上呈逐年升高的趋势,从41.24%增长至51.50%,预约诊疗率逐年增长,预约后平均等待时间缩短,年度门诊患者、住院患者及医务人员调查满意度基本呈上升趋势。结论医院实施DRG支付制度后医保管理改革取得了较好成效,对医院的医疗服务管理能力产生了一定的影响。Under the background of deepening the reform of the national medical system,the disease diagnosis related grouping(DRG)payment system will gradually replace the previous project payment system,which poses a new challenge to the business model of medical institutions.Controlling costs and reducing costs and improving the quality of medical services will become the core content of competition among medical institutions in the future.In order to adapt to the DRG payment reform,the functional departments and operation modes of various medical institutions are facing great adjustments.How to carry out scientific and reasonable medical insurance management under the background of DRG medical reform is the central task being discussed in recent years.Through the interpretation of the national DRG macro policy and drawing lessons from the experience of the pilot cities in the DRG reform in recent years,this paper further discusses the feasible scheme of hospital medical insurance management under the reform of DRG payment system,so as to provide a basis for the full implementation of DRG payment system in the later stage.

关 键 词：疾病诊断相关分组 医保 支付制度 医院管理 

分 类 号：R197.32[医药卫生—卫生事业管理]