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我国DRG支付方式改革中同病同价政策实施现状分析

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我国DRG支付方式改革的权重计算普遍采用历史数据法,为适应各级医疗机构诊疗费用的差异,各地往往设置了等级系数对病组付费标准进行调整.然而,等级系数在一定程度上会固化高级别医疗机构的"虹吸效应".为推进分级诊疗制度建设,部分地区遴选适于在基层医疗卫生机构治疗的基础病组,取消等级系数,实现"同病同价".文章在深入探讨我国同病同价政策背景及原理的基础上,梳理当前同病同价政策实施现状,分析基础病组的遴选标准及特征,并结合实证数据分析基础病组遴选结果是否合理,为完善我国DRG支付方式改革、协同推进分级诊疗制度提供参考.
Analysis on the Implementation of Same Disease Same Price Policy within DRG Payment Reform in China
In China,the cost weight of Diagnosis Related Group (DRG) payment generally adopts the historical data method. In order to adapt to medical costs at different levels of hospitals,medical insurance departments often set a grade coefficient to adjust the payment standard. However,the grade coefficient could solidify the"siphon effect"of high-level hospitals to some extent. In order to promote hierarchical diagnosis and treatment,some region select certain basic group which is suitable for treatment in primary hospitals,and cancel grade coefficient to achieve"same disease same price". It discusses the background and principle of same-disease-same-price policy,sorts out the current implementation status,analyzes the selection criteria and characteristics of basic DRG group and evaluates whether the selected groups coordinate policy principle,so as to provide references for improving the reform of DRG payment and promoting the hierarchical diagnosis and treatment system in China.

Diagnosis Related Group Paymentsame disease same pricehierarchical diagnosis and treatment

任雨青、李伟、陈逸凡、葛梦茹、丁锦希

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中国药科大学国际医药商学院 江苏 南京 211198

中国药科大学医药市场准入政策研究中心 江苏 南京 211198

疾病诊断相关分组付费 同病同价 分级诊疗

2024

中国卫生经济
中国卫生经济学会,卫生部卫生经济研究所

中国卫生经济

CSTPCDCHSSCD北大核心
影响因子:1.524
ISSN:1003-0743
年,卷(期):2024.43(12)