摘要
随着DRG付费模式的全面推行,其通过固定病种支付标准优化资源配置、控制医疗成本的制度优势逐步显现,但也引发了医患关系的结构性价值冲突。基于医学伦理四个基本原则,构建DRG付费模式下医患关系价值冲突的分析框架。从价值冲突的表现入手,深入分析产生价值冲突的诱因。在此基础上,提出多维优化路径:通过信息透明化与决策共治修复尊重性冲突;构建精细化成本管理体系并嵌入伦理审查机制化解不伤害性冲突;实施创新技术分阶段支付与伦理审核豁免机制缓解有利性冲突;设计动态支付规则、统一参保类型支付标准并强化动态监测以修复公正性冲突。在此框架下,以期促进DRG逐步从控费工具转向治理工具,在保障基金安全的同时,守住质量底线、激活技术革新、回归患者本位,推动医患关系从零和博弈转向共生共赢。
With the full implementation of the Diagnosis Related Groups(DRG)payment model,its institutional advantages in optimizing resource allocation and controlling medical costs through fixed disease payment standards have gradually emerged.However,it has also triggered structural value conflicts in the doctor-patient relationship.Based on the four principles of medical ethics,this paper constructed an analytical framework for the value conflicts in doctor-patient relationships under the DRG payment model.Starting from the manifestations of value conflicts,the inducements creating them were analyzed in depth.On these foundations,multi-dimensional optimization paths were proposed,including repairing respect-related conflicts through information transparency and decision-making co-governance;constructing a refined cost management system and embedding an ethical review mechanism to resolve non-harm conflicts;implementing a phased payment mechanism for innovative technologies and an ethical review exemption mechanism to alleviate benefit conflicts;as well as designing dynamic payment rules,unifying payment standards for insurance participation types,and strengthening dynamic monitoring to address justice conflicts.Under this framework,this paper aimed to promote the gradual transformation of DRG from a cost-control tool to a governance tool.While ensuring the security of the fund,it was necessary to maintain the bottom line of quality,stimulate technological innovation,and return to the patient-centered concept,thereby promoting the doctor-patient relationship to shift from a zero-sum game to a symbiotic and win-win situation.
作者
任晋文
朱佳英
季建珺
李霞
REN Jinwen;ZHU Jiaying;JI Jianjun;LI Xia(Medical Insurance and Price Administration Office,Zhejiang Provincial People’s Hospital/People’s Hospital of Hangzhou Medical College,Hangzhou 310014,China)
出处
《中国医学伦理学》
北大核心
2025年第8期1022-1028,共7页
Chinese Medical Ethics
基金
浙江省科学技术厅软科学研究项目“基于大数据的DRG入组智能监管机制探索”(2022C35105)。
关键词
DRG付费
医患关系
价值冲突
动态治理
Diagnosis Related Groups payment
doctor-patient relationship
value conflict
dynamic governance
