摘要
目的:分析DRG支付改革的政策演进路径及实施情况,探究价值医疗导向下DRG支付改革与医院运营绩效之间的作用机制。方法:采用文献研究与深度访谈相结合。系统检索相关文献,运用VOSviewer梳理DRG政策演进与实施效果;通过半结构化访谈,采用主题分析法挖掘DRG支付改革对医院成本控制、服务效率及医疗质量的影响路径。结果:DRG支付改革研究呈现政策驱动特征;核心研究力量集中于三甲医院及医保部门;跨机构合作不足;高频词从“成本核算”转向“AI分组”。访谈结果显示,DRG支付改革通过建立“病组-成本-绩效”闭环管理实现耗材支出降低,在缩短平均住院时间的同时依托日间手术中心建设控制再入院风险,并通过DRG分组与临床结局指标联动降低医院并发症率,形成成本控制、服务效率与医疗质量协同提升的三维优化路径。结论:价值医疗导向下DRG支付改革通过预付制压力传导促进医院提质增效,但需构建“质量-成本”动态平衡机制,重点突破基层医院适配与中医药支付创新。
Objective:To analyze the policy evolution and implementation of DRG payment reform,and to explore the mechanisms through which DRG payment reform affects hospital operational performance under a value-based healthcare orientation.Methods:A combination of literature review and in-depth interviews was adopted.Relevant literature was systematically retrieved,and VOSviewer was used to map the policy evolution and implementation effects of DRG reform.Semi-structured interviews were conducted,and thematic analysis was applied to identify pathways through which DRG payment reform influences hospital cost control,service efficiency,and medical quality.Results:Studies on DRG payment reform show clear policy-driven characteristics;core research efforts are concentrated in Grade III Level A Hospitals and medical-insurance departments;cross-institution collaboration is insufficient;and high-frequency terms have shifted from“cost accounting”to“AI grouping.”Interview results indicate that DRG payment reform reduces consumables expenditure by establishing a“diagnosis-related group–cost–performance”closed-loop management model,shortens average length of stay while controlling readmission risks through the development of day-surgery centers,and reduces hospital complication rates by linking DRG grouping with clinical outcome indicators—forming a three-dimensional optimization pathway that simultaneously enhances cost control,service efficiency,and medical quality.Conclusion:Under a value-based healthcare orientation,DRG payment reform promotes quality improvement and efficiency gains in hospitals through the pressure of prospective payment.However,it remains necessary to build a dynamic“quality–cost”balance mechanism and to prioritize breakthroughs in the adaptation of DRG reform for primary hospitals and innovations in traditional Chinese medicine payment models.
作者
李松平
杨伟吉
罗干
汪传来
周莉雪
LI Songping;YANG Weiji;LUO Gan;WANG Chuanlai;ZHOU Lixue(The Second Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou,Zhejiang Province,310005,PRC)
出处
《中国医院》
北大核心
2026年第1期84-87,共4页
Chinese Hospitals
基金
国家中医药综合改革示范区(浙江省)科技共建项目(GZY-KJS-ZJ-2026-051)。
关键词
DRG支付
支付改革
价值医疗
医院运营
政策分析
DRG payment
payment reform
value-based healthcare
hospital operation
policy analysis
