医方伦理风险治理路径与逐利行为逻辑成因的机制研究  

Research on the Governance Path of Medical Ethics Risks and the Logical Causes of Profit-seeking Behavior

作　　者：李娟 林振平[1] LI Juan;LIN Zhenping(School of Health Policy&Management,Nanjing Medical University,Nanjing 210029,China;Department of Medical Records,The Friendship Hospital of Ili Kazakh Autonomous Prefecture,Yining 835100,China)

机构地区：[1]南京医科大学医政学院,江苏南京210029 [2]伊犁哈萨克自治州友谊医院医务科,新疆伊宁835100

出　　处：《医学与哲学》2025年第4期51-55,共5页Medicine and Philosophy

基　　金：2022年伊犁哈萨克自治州科技计划项目(YZ2022BA09)。

摘　　要：疾病及诊断相关分组医保制度下,医方处于卫生信息掌控的优势地位,为其实现利益获得提供了一定空间,由此产生诸多伦理风险成为改革面临的重大难题。通过总结医方伦理风险类型与具体表现,从宏观政策与微观制度层面,对行为动机缘由加以剖析。研究认为,医方伦理风险源于宏观政策调控能力不足,及微观制度下经济规模扩张与公益性冲突的管理短视;风险行为是疾病及诊断相关分组付费下激励措施传导途径不畅通,医方对成本激励措施曲解下的行为异化,其既能满足经济利益也能收获社会效益。通过建立支付权重变动预警提升伦理风险准入门槛,引入人工智能辅助编码收紧风险路径。Under the diagnosis related groups(DRG)medical insurance system,medical institutions are in a dominant position in the control of healthcare information,providing them with opportunities to maximize their benefits.Consequently,numerous ethical risks arise,posing significant challenges to reform efforts.By summarizing the types and specific manifestations of medical ethical risks,this paper analyzes the causes of behavior motivation from both macro-policy and micro-institutional perspectives.The study believes that the ethical risks stem from inadequate macro-level policy regulation and the short-sighted management regarding the conflict between economic expansion and public welfare under micro-level institutional frameworks.Risk behaviors result from ineffective transmission of incentive mechanisms under DRG-based payment and the misinterpretation of cost incentives by medical institutions,leading to behavioral distortions that fulfill both economic and social interests.To address these issues,the study proposes establishing an early warning system for payment weight fluctuations to raise the ethical risk entry threshold and introducing AI-assisted coding to tighten risk pathways.

关 键 词：疾病及诊断相关分组 伦理风险 行为逻辑 

分 类 号：R-05[医药卫生]