摘要
按照国务院办公厅关于深化基本医疗保险支付方式改革文件的要求,国家医保局于2019年5月在30个城市开展按疾病诊断相关分组(DRG)付费试点,2020年10月在71个城市开展区域点数法总额预算和按病种分值(DIP)付费试点,住院服务的支付方式改革对医保基金管理和医疗机构运营将产生重要影响。文章从DRG与DIP的概念、分类规则、数据标准、支付标准测算、配套政策制定等方面比较二者的异同点,探讨试点过程中可能产生的影响和风险,从顶层设计、试点实施、医院管理等角度提出政策建议,为DRG和DIP的改革实践提供借鉴参考。
According to the guidance on deepening basic insurance payment reform issued by the State Council,Diagnosis-related Group(DRG)in 30 pilot cities and Diagnosis-Intervention Packet(DIP)under the Point-based Regional Global Budget in 71 pilot cities were launched in May 2019 and in October 2020 respectively by National Healthcare Security Administration.These two inpatient payment reforms will have the profound and lasting impact on the behavior and operation of providers as well as on the management of insurers.It compared the similarities and differences of the concepts,classification rules,data standards,payment standard calculations,and supporting policy formulation of DRG and DIP,discussed the possible impacts and risks during the piloting process.In addition,it proposed policy recommendations from the perspectives of top-level design,pilot implementation,and hospital management to provide references for the reform practices of DRG and DIP.
作者
傅卫
江芹
于丽华
郎婧婧
张毓辉
FU Wei;JIANG Qin;YU Li-hua(China National Health Development Research Center of National Health Commission,Beijing,100044,China)
出处
《中国卫生经济》
北大核心
2020年第12期13-16,共4页
Chinese Health Economics
关键词
疾病诊断相关分组
按病种分值付费
医疗机构
影响分析
Diagnosis-related Group
Diagnosis-Intervention Packet
medical institution
impact analysis
作者简介
傅卫(1966-),女,研究员,研究方向:健康经济,卫生改革、健康产业、健康中国等,E-mail:fuwei@nhei.cn;通信作者:江芹,E-mail:9861541@qq.com。
