异地就医对DRG/DIP支付方式的影响及对策分析  

Research on the influence of off-site medical treatment on DRG/DIP payment method and corresponding strategies

作　　者：任平平 陈勇 赵允伍 蒋心梅[3] 王珩[1,4] REN Pingping;CHEN Yong;ZHAO Yunwu;JIANG Xinmei;WANG Heng(School of Health Management,Anhui Medical University,Hefei 230032;Department of Post-Graduate Education,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Medical Insurance Department,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Dean’s Office,the 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,安徽合肥230032 [2]安徽医科大学第一附属医院毕业后教育处,徽合肥230022 [3]安徽医科大学第一附属医院医保处,徽合肥230022 [4]安徽医科大学第一附属医院院长办公室,安徽合肥230022

出　　处：《南京医科大学学报(社会科学版)》2025年第1期16-20,共5页Journal of Nanjing Medical University(Social Sciences)

基　　金：国家自然科学基金面上项目“DRG支付方式下的医保—医疗协同机制研究”(72374004);国家卫生健康委医院管理研究医疗质量(循证)管理研究项目“DRG支付下的医保—医疗质量协同管理路径研究”(YLZLXZ23K013)。

摘　　要：异地就医是我国医保体制下的一项有益政策安排,但在运行过程中,异地就医面临就医秩序混乱、成本转移风险频发、医保基金控费困难、监管难度大、管理碎片化等问题,与按疾病诊断相关分组(DRG)或病种分值付费(DIP)支付方式改革存在许多不协调之处。文章通过系统分析异地就医推行过程中存在的问题,探讨DRG/DIP支付方式改革的潜在影响因素,并提出解决策略和建议,为加快异地就医实现按DRG/DIP付费提供参考。Off-site medical treatment is a beneficial policy arrangement under China’s medical insurance system.However,in the operation process,off-site medical treatment is facing problems such as chaotic treatment order,frequent switching costs risks,difficulties in medical insurance fund cost control,major regulatory challenges,and fragmentation of management.There are many inconsistencies with the reform of DRG/DIP payment methods.By systematically analyzing the problems existing in the implementation of off-site medical treatment,this paper discusses the potential influencing factors of existing problems on the reform of DRG/DIP payment methods and puts forward strategies and suggestions to address these challenges to provide a practical reference for accelerating the implementation of DRG/DIP payment in off-site medical treatment.

关 键 词：DRG/DIP支付方式改革 异地就医 医保基金 

分 类 号：R197.1[医药卫生—卫生事业管理]