基于史密斯政策执行过程模型的我国DRG政策执行困境与对策分析  

Analysis of DRG policy implementation dilemma and countermeasures of China based on Smith policy implementation process model

作　　者：吕曼辰 周典[2] 田帝 周苑 张钰 薛同斌 刘雪珍 吴烨 Lyu Manchen;Zhou Dian;Tian Di;Zhou Yuan;Zhang Yu;Xue Tongbin;Liu Xuezhen;Wu Ye(School of Health Management,Anhui Medical University,Hefei 230032,China;Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China;Medical Department,First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;League Committee Office,Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China;Personnel Department,First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学卫生管理学院,合肥230032 [2]安徽医科大学第二附属医院,合肥230601 [3]安徽医科大学第一附属医院医务处,合肥230022 [4]安徽医科大学第二附属医院团委办公室,合肥230601 [5]安徽医科大学第一附属医院人事处,合肥230022

出　　处：《中华医院管理杂志》2024年第9期662-665,共4页Chinese Journal of Hospital Administration

基　　金：国家卫生健康委医院管理所研究项目(YLZLXZ22K001);安徽医科大学医院管理研究所开放项目(2022GYKJ06)。

摘　　要：DRG付费改革是控制医疗费用不合理增长、提升医疗服务质量和实现医保患三方共赢的重要手段。本研究采用史密斯政策执行过程模型,从理想化政策、政策执行机构、目标群体和政策环境4方面分析了DRG政策执行过程的困境,包括政策内涵与实际需求存在一定偏差;各方主体利益目标不完全一致,目标群体认同感不足,以及社会影响和技术支撑有待完善等。本研究建议,应从政策供给协调性与精准性、绩效考核与人员素养、目标群体认知水平与参与意愿以及政策执行环境与氛围4个维度进行优化,协同推进DRG政策的有效落地落实。DRG payment reform is an important means to control the unreasonable growth of medical expenses,improve the quality of medical services and achieve a win-win situation among three sides of hospitals,medical insurance and patients.This study adopted the Smith policy implementation process model to analyze the difficulties in the DRG policy implementation process from four aspects(idealized policies,policy implementation institutions,target groups,and policy environment),including the deviation between policy connotations and actual needs;the interest objectives of all parties were not completely aligned,the target group lacked a sense of identity,and the social impact and technological support needed to be improved.It was suggested that optimization should be carried out from four dimensions:policy supply coordination and precision,performance evaluation and personnel literacy,target group cognitive level and participation willingness,and policy implementation environment and atmosphere,in order to synergistically promote the effective implementation of DRG policies.

关 键 词：疾病诊断相关分组 史密斯政策执行过程模型 政策执行 困境分析 策略 医院 公立 患者 

分 类 号：R197.1[医药卫生—卫生事业管理]