Abstract:During the “13th Five-Year Plan” period of medical reform, Chinese diagnosis-related groups (DRG) payment system reform achieved remarkable pilot results, and eight mainstream diagnosis-related groups (DRG) versions appeared successively. As a master, China healthcare security diagnosis related groups has initially formed a DRG payment system with Chinese characteristics. In the future, it needs to consolidate the coding system to help improve the grouping scheme, and strengthen the design of supporting system and the construction of evaluation system. DIP payment will coordinate with DRG to promote the reform and expansion of payment methods. Public hospitals should effectively develop and utilize DRG tools, strengthen cost awareness, and make concerted efforts in medical insurance management, performance management, medical management, nursing management, etc., so as to stimulate clinical endogenous dynamics and form a DRG-based three-dimensional hospital management system supported by information technology.
唐佳骥. “十三五”深化医疗体制改革期间我国疾病诊断相关分组付费支付方式改革进展及未来展望[J]. 中国医药导报, 2022, 19(29): 193-封三.
TANG Jiaji. Progress and future prospects of diagnosis-related groups in China during “the 13th Five-Year Plan” to deepen the reform of the medical system. 中国医药导报, 2022, 19(29): 193-封三.
[1] 中共中央国务院.中共中央国务院关于深化医疗保障制度改革的意见[EB/OL].(2020-03-05)[2021-11-26].http://www.gov.cn/zhengce/2020-03/05/content_5487407.htm.
[2] 中共中央国务院.中共中央国务院关于深化医药卫生体制改革的意见[EB/OL].(2009-04-08)[2021-11-26].http://www.gov.cn/test/2009-04/08/content_1280069.htm.
[3] 国务院.国务院关于印发“十二五”期间深化医药卫生体制改革规划暨实施方案的通知[EB/OL].(2012-03-21)[2021-11-26].http://www.gov.cn/zhengce/content/2012-03/21/content_6094.htm.
[4] 国务院.国务院关于印发“十三五”深化医药卫生体制改革规划的通知[EB/OL].(2017-01-09)[2021-11-26].http://www.gov.cn/zhengce/content/2017-01/09/content_5158053. htm.
[5] 人民网.习近平在中国共产党第十九次全国代表大会上的报告[EB/OL].(2017-10-28)[2021-11-26].http://cpc.people.com.cn/n1/2017/1028/c64094-29613660-10.html.
[6] 国务院办公厅.国务院办公厅关于进一步深化基本医疗保险支付方式改革的指导意见[EB/OL].(2017-06-28)[2021-11-26].http://www.gov.cn/zhengce/content/2017-06/28/content_5206315.htm.
[7] Fetter R,Shin Y,Freeman J,et al. Case mix definition by diagnosis-related groups [J]. Medical Care,1980,18(2):1-53.
[8] Katherine L,Lisa V,David D,et al. The effects of the DRG-based prospective payment system on quality of care for hospitalized Medicare patients. An introduction to the series [J]. JAMA,1990,264(15):1953-1955.
[9] Reinhard B,Alexander G,Wilm Q,et al. Diagnosis-Related Groups in Europe Moving towards transparency,efficiency and quality in hospitals [M]. England:Open University Press,2011:5.
[10] Inke M,Friedrich W. Hospital payment systems based on diagnosis related groups:experiences in low and middle-income countries [J]. Bull World Health Organ,2013,91(10):746-756.
[11] 黄慧英,朱美英,张修梅,等.诊断相关分类开发(DRGs)与我国的医院管理[J].中国医院管理,1989,增刊3:59.
[12] 简伟研,卢铭,胡牧.北京诊断相关组(BJ-DRGs)分组效果的初步评价[J].中华医院管理杂志,2011,27(11):854-856.
[13] 胡牧,杜圣普,陈剑铭.诊断相关组与预定额付费的应用条件和效果——以北京某医院DRGs-PPS试点为例[J].中国医疗保险,2013,6(5):32-34.
[14] 胡广宇,刘婕.我国按疾病诊断相关分组预付费改革进展及建议[J].中华医院管理杂志.2017,10(9):32-38.
[15] 国家医保局.关于印发疾病诊断相关分组(DRG)付费国家试点技术规范和分组方案的通知[EB/OL].(2019-10-24)[2021-11-26].http://www.nhsa.gov.cn/art/2019/10/24/art_37_1878.html.
[16] 国家医保局等.关于印发按疾病诊断相关分组付费国家试点城市名单的通知[EB/OL].(2019-06-05)[2021-11-26].http://www.nhsa.gov.cn/art/2019/6/5/art_37_1362.html.
[17] George P,Beth R. Evaluation of the performance of diagnosis-related groups and similar casemix systems:methodological Issues [J]. Health Serv Manage Res,2001, 14(2):71-81.
[18] 王禄生,杨青.新型农村合作医疗支付方式改革操作指南[M].北京:人民卫生出版社,2015:272-291.
[19] 魏倩,陈尔真,孙木.S-DRG分组器的构建与改进方法[J].中国卫生质量管理,2020,27(1):61-65.
[20] 李乐乐.健康中国战略下我国基本医疗保险支付方式改革政策评估[J].宁夏社会科学,2019(5):125-134.
[21] 江芹,徐志銮,于丽华,等.三明市C-DRG收付费对医疗机构的费用影响分析[J].中国卫生经济,2021,40(4):13-16.
[22] 浙江省医疗保障局.关于印发浙江省医疗保障疾病诊断相关分组细分组目录的通知[EB/OL].(2020-09-08)[2021-11-26].http://ybj.zj.gov.cn/art/2020/9/8/art_12292 25623_1284089.html.
[23] 赵思雨,马艳良,王茹.诊断相关分组下的除外机制探讨[J].中国社会保障,2020,25(12):86-87.
[24] 郑秉文.“十四五”时期医疗保障可持续性改革的三项任务[J].社会保障研究,2021,14(2):3-14.
[25] 唐佳骥,宋磊,张彤彦,等.北京某院DRGs收付费模拟运行效果评价[J].中国卫生质量管理,2020,27(3):47-50.
[26] 唐佳骥,张彤彦,许欣悦.DRGs付费改革效果评估指标框架研究[J].中国医院,2020,24(5):19-21.
[27] 别凤赛.按疾病诊断相关分组(DRGs)支付方式改革评价指标体系构建研究[D].北京:北京协和医学院,2019.
[28] 国家医疗保障局.国家医疗保障局关于印发DRG/DIP 支付方式改革三年行动计划的通知[EB/OL].(2021-11-26)[2021-11-26].http://www.nhsa.gov.cn/art/2021/11/26/art_37_7406.html.
[29] 周东旭.为什么必须重提“医疗体制改革”——专访中国社科院世界社保研究中心主任郑秉文[J].中国改革,2016,27(5):6-14.
[30] 李鑫,熊莉娟,何嘉,等.疾病诊断相关分组在护理管理中的应用进展[J].中华护理杂志,2020,56(4):636-640.