DRG组恶性肿瘤靶向、免疫治疗支付管理调查研究  

Investigation on the Payment Management of Targeted Therapy and Immunotherapy for Malignant Tumors in DRG Group

作　　者：张丽成 高明 冷家骅[1] Zhang Licheng;Gao Ming;Leng Jiahua(Peking University Cancer Hospital&Institute/Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing),Beijing,100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所·恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《中国医院管理》2025年第2期50-52,共3页Chinese Hospital Management

摘　　要：目的 调查医疗机构疾病诊断相关分组(DRG)组恶性肿瘤靶向、免疫治疗(RG19)支付管理情况,为完善DRG相关制度提供参考建议。方法 对全国22个DRG试点城市的96家综合医院和肿瘤专科医院的临床医生、医保工作人员开展问卷调查,包括RG19组支付管理情况、各地区特殊支付政策等。结果 共收集有效问卷148份。调查结果显示,37%的医院RG19组呈现亏损状态,主要原因是创新药的使用以及靶向、免疫联合治疗病例占比较高。46%的调查对象认为RG19组的支付标准不能很好地体现诊疗方案制定的价值,分组规则有待进一步优化,需综合考虑疾病分线治疗情况、药品使用类型等因素。此外,24%的医院RG19组的盈利原因在于临床试验病例占比较高,但大部分地区对临床试验病例支付并无特殊政策。结论 建议医疗机构进一步加强DRG组的费用管理,各地区在DRG分组规则和支付方案制定上应更加注重符合临床实际。Objective To investigate the cost and payment management of DRG group malignant tumor targeted therapy and immunotherapy(RG19) in medical institutions,and provide reference suggestions for further improving DRG related systems. Methods A questionnaire survey was conducted on clinical doctors and medical insurance staff from 96 comprehensive hospitals and oncology specialized hospitals in 22 DRG pilot cities in China. The questions included the hospital management of RG19 group,and special payment policies in different regions. Results A total of 148 valid questionnaires were collected. The survey results showed that 37% of hospitals in the RG19 group was in a loss state, mainly due to the use of innovative drugs and the high proportion of targeted therapy and immunotherapy combined cases. 46% of respondents believed that the current payment standards for RG19 group did not fully reflect the value of doctor plan development,and the grouping rules needed to be further optimized.Factors such as line of treatment,and drug use types should be comprehensively considered. In addition,24% of hospitals RG19 group made profits due to the high proportion of clinical trial cases,but most regions did not have special policies for payment of clinical trial cases. Conclusion Medical institutions should further strengthen the management of hospital internal cost control for DRG patients, and regions should pay more attention to clinical practice in formulating DRG grouping rules and payment schemes.

关 键 词：疾病诊断相关分组 靶向、免疫治疗 支付管理 

分 类 号：R197.1[医药卫生—卫生事业管理]