首页|医保支付改革视角下DRG成本核算若干问题及建议

医保支付改革视角下DRG成本核算若干问题及建议

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在医保支付改革中,高质量的DRG成本核算至关重要。当前,DRG成本核算存在分组器等核心逻辑不透明、没有扣除财政基本拨款收入形成的各项费用、成本核算方法选择困难等问题。对此,各地医保部门应尽量公开DRG分组器和支付标准,提高透明度和公平性,强化监管和审核,并建立反馈机制;基于制定支付标准的目的,DRG成本核算应扣除财政基本拨款收入形成的各项费用,形成精准的成本数据;精益化开展基于项目叠加法的DRG成本核算。
Issues and Suggestions on DRG Cost Accounting under the Perspective of Medical Insurance Payment Reform
In the process of DRG payment reform,high-quality DRG cost accounting is crucial.There are some problems in DRG cost accounting,such as the opaque core logic of the grouping unit,the failure to deduct various expenses formed by financial basic appropration revenues,and difficulties in selecting cost accounting methods.In this regard,local medical insurance departments should publicize DRG grouping unit and payment standards as much as possible,improve transparency and fairness,strengthen supervision and auditing,and es-tablish a feedback mechanism.Based on the purpose of setting payment standards,DRG cost accounting should deduct the expenses formed by financial basic appropration revenues,form accurate cost data;and carry out refined DRG cost accounting based on the project super-position method.

medical insurance payment reformDRGcost accounting

夏培勇

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上海申康医院发展中心,上海 200041

上海市第六人民医院,上海 200233

医保支付改革 DRG 成本核算

2025

卫生经济研究
华东卫生经济研究协作会

卫生经济研究

北大核心
影响因子:1.01
ISSN:1004-7778
年,卷(期):2025.42(1)