按DRG预付费制度对医疗服务影响的国外实践与启示  

Overseas Practices and Implications of the Impact of Prepayment System according to DRG on Medical Services

作　　者：曹珍[1] 张楠[1] 孙静[1] 张立强 薛清元[1] 管仲军 Cao Zhen(Inner Mongolia Medical University,Hohhot,P.R.China)

机构地区：[1]内蒙古医科大学,内蒙古呼和浩特010107 [2]首都医科大学国家医保研究院 [3]首都医科大学宣武医院

出　　处：《中国卫生事业管理》2025年第2期168-171,228,共5页Chinese Health Service Management

基　　金：国家自然科学基金“基于灰色建模技术的民族地区居民基本医疗保险筹资预测研究”(72064032);内蒙古自然科学基金“内蒙古自治区医保药品支付标准政策效果评价与优化研究—基于多方演化博弈模型的视角”(2024MS07007);内蒙古自治区“草原英才”工程青年创新创业人才项目;国家自然科学基金委员会“中国医保药品支付标准政策效果评价与优化研究”(72274008);内蒙古自治区人才开发基金资助项目。

摘　　要：目的:梳理按DRG预付费制度在国际上的发展演变和实施情况,总结典型应用国家医疗服务的变化,以及为抑制负面影响采取的政策优化和监管策略,为我国医保支付方式改革的顺利推进提供借鉴。方法:采用文献研究和二手资料分析法,梳理各个国家或地区按DRG预付费制度的改革实践,总结共性,寻找差异,以期全面反映该制度在世界范围内的演进历程和实际应用情况。结果:DRG实现了对病例的标准化分类,大多数国家将DRG与预付费制结合,作为医保支付的工具。按DRG预付费制度对医疗服务既有积极影响,也有非预期结果。各国和地区的医疗保险体系和医疗服务体系均存在较大差异,研究结论的外推性和对全局性的指导有限。结论:我国亟待开展DRG预付费制度改革情境下的更加深入的理论与实证研究,评估付费改革对医疗服务的客观影响。借鉴国际经验为相关部门及时调整政策提供实证依据,为付费改革在全国的推广提供参考。Objective To sort out the development evolution and implementation of the international prepayment system according to DRG,summarize the changes in healthcare services in typical application countries and the policy optimization and regulatory strategies,and provide a reference for the promotion of the reform of China's healthcare insurance payment method.Methods Literature research and secondary data analysis were used to sort out the reform practices of the prepayment system according to DRG in each country or region,summarize their commonalities and look for the differences.Results DRG achieved the standardized classification of cases.Most countries combined DRG with prepayment system as a tool for health insurance payment.The prepayment system according to DRG has both positive and unintended effects on healthcare services.In addition,health insurance systems and healthcare delivery systems vary widely across countries and regions,which means that the study's findings have limited overall extrapolation and guidance.Conclusion China urgently needs to conduct more in-depth theoretical and empirical research in the context of prepayment reform to assess the objective impact of payment reform on healthcare services.The international experience can be drawn on to provide empirical evidence for the relevant departments to adjust their policies in a timely manner,and provide a reference for the promotion of the national payment reform.

关 键 词：DRG 预付费 医疗服务 国际实践 

分 类 号：R197.1[医药卫生—卫生事业管理]