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[1]李迪夏家红孙晖舒琴蒋竞孙扬辛艳姣陶红兵徐小兵潘小凯.基于分组差异比较的CHS-DRG付费优化方案研究[J].中国卫生质量管理,2026,33(6):43-47.[doi:10.13912/j.cnki.chqm.2026.33.6.09]
　LI Di,XIA Jiahong,SUN Hui.Research on CHS-DRG Payment Optimization Plan Based on Comparative Analysis of Group Differences[J].Chinese Health Quality Management,2026,33(6):43-47.[doi:10.13912/j.cnki.chqm.2026.33.6.09]

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基于分组差异比较的CHS-DRG付费优化方案研究

《中国卫生质量管理》[ISSN:1006-7515/CN:CN 61-1283/R] 卷: 33 期数: 2026年6期页码: 43-47 栏目: 医疗质量出版日期: 2026-06-15

Title:: Research on CHS-DRG Payment Optimization Plan Based on Comparative Analysis of Group Differences

作者:: 李迪夏家红孙晖舒琴蒋竞孙扬辛艳姣陶红兵徐小兵潘小凯; 华中科技大学同济医学院附属协和医院

Author(s):: LI Di; XIA Jiahong; SUN Hui; Union Hospital, Tongji Medical College, Huazhong University of Science and Technology

关键词:: CHS-DRG; DRG分组; DRG付费; 分组差异; 费率

Keywords:: CHS-DRG; DRG Grouping; DRG Payment; Group Differences; Payment Rate

分类号:: R197.3

DOI:: 10.13912/j.cnki.chqm.2026.33.6.09

文献标志码:: A

摘要:: 目的以武汉市两所三级医院为例，探索基于分组差异比较的CHS-DRG付费优化方案。方法选取一所医疗资源优势明显、医疗成本较高的委属委管医院作为实验医院，一所普通三级医院作为对照医院，通过三步筛选法识别医疗费用和平均住院日，实验医院均显著高于对照医院，且难以通过内部控费措施缩小组间费用差距的DRG组。结果共筛选出20个DRG组，其在实验医院的次均住院费用较高，平均住院日较短，且控费难度大；在现行付费下支付存在缺口；通过将费率分别提升5%、20%、50%，实验医院费用差额分别缩小425.7万元、1 703.0万元和4 257.4万元。结论在CHS-DRG付费机制下，对部分资源消耗较高的医疗机构或特定DRG组别进行费率调整是现阶段较为可行的优化手段，而细化DRG分组方案仍是长期优化措施，规范编码和分组轮算有助于提高付费准确性。

Abstract:: ObjectiveTaking two tertiary hospitals in Wuhan as examples, to explore an optimization plan for CHS-DRG payment based on a comparative analysis of group differences.MethodsA hospital under the direct administration of a commission, characterized by significant medical resource advantages and relatively high medical costs, was selected as the experimental hospital, while an ordinary tertiary hospital served as the control hospital. A three-step screening method was employed to identify DRG groups where medical expenses and length of stay in the experimental hospital were significantly higher than those in the control hospital, and where the cost gap between the two groups was difficult to narrow through internal cost-control measures.Results A total of 20 DRG groups were identified. These groups exhibited higher average costs and shorter average lengths of stay in the experimental hospital, along with significant challenges in cost control. Under the current payment system, there were payment shortfalls for these groups. By increasing the payment rates by 5%, 20%, and 50%, respectively, the cost gap in the experimental hospital was reduced by 4.257 million yuan, 17.030 million yuan, and 42.574 million yuan, respectively.Conclusion Under the CHS-DRG payment mechanism, adjusting payment rates for certain medical institutions with higher resource consumption or specific DRG groups represents a feasible optimization approach at the current stage, while refining DRG grouping schemes remains a long-term optimization measure. Standardizing coding and implementing group recalculations contribute to enhancing payment accuracy.

参考文献/References:

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更新日期/Last Update: 2026-06-15