我国医保支付改革下按病种分值付费的探讨与建议
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发布人:yaot 发布时间:2022/5/10 17:04:26  浏览次数:1115次
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——龙雨曦 袁向东 黎浩

【摘要】医保支付方式作为引导医疗服务行为、调节资源配置的杠杆,对实现医保基金可持续发展,提升医院精细化管理水平具有重要作用。近年来,我国积极探索医保支付改革,以DRG和DIP为代表的支付方式已成为主要方向。文章从改革的现实出发,对DIP相较于DRG的实施优势、问题与挑战进行比较分析,并提出政策建议。
【关键词】按病种分值付费;疾病诊断相关组;医保支付;优势;挑战;建议
中图分类号:R197.323文献标识码:A
Exploration and Suggestions of Implementing Diagnosis Intervention Packet under the Reform of Medical Insurance Payment in China/LONG Yuxi,YUAN Xiangdong,LI Hao.//Chinese Health Quality Management,2022,29(4):18-20,29
Abstract Medical insurance payment is an important lever to regulate medical service behavior and guide the allocation of medical resources. It plays a significant role in realizing the sustainable development of medical insurance fund and improving fine management level of hospitals. In recent years, China has actively explored the reform of medical insurance payment, and DRG and DIP have become the main directions of the payment reform. The study discussed the advantages, problems and challenges of DIP compared with DRG based on the reality of reform, together with some suggestions for policy.
Key words Diagnosis Intervention Packet(DIP); Diagnosis Related Group(DRG); Medical Insurance Payment; Advantage; Challenge; Suggestion
Firstauthor's address School of Public Health, Wuhan University, Wuhan,Hubei,430071,China


2018年底,国家医保局正式启动按疾病诊断相关组(Diagnosis Related Group,DRG)付费准备工作,并于2019年5月公布30个试点城市名单,探索建立DRG付费体系。 DRG付费在控制医保费用不合理增长、减轻患者住院负担、规范医疗服务行为、优化医院收入结构等方面初见成效。但是,对分组器依赖程度高、数据质量达不到要求、编码能力不足等使DRG在我国的实施难以一蹴而就。基于按病种付费、点数法和大数据在我国医疗卫生领域的应用发展,总额控制下的按病种分值付费(Diagnosis Intervention Packet,DIP)应运而生。2020年10月,国家医保局发布《区域点数法总额预算和按病种分值付费试点工作方案》,开始在全国推广实施DIP,试点覆盖了71个城市。与DRG在我国的发展进程相比,DIP起步较晚。目前,关于这两种支付方式异同点的讨论主要是从制度设计和技术层面出发[1-2]。随着改革试点工作不断推进,DIP展现出独有的优势,也面临着新的问题和挑战。本研究基于现实对DIP和DRG进行比较,总结DIP优势,厘清其问题和挑战,并提出管理及政策建议。