摘要
目的:探讨DRG/DIP付费对医疗服务能力、效率、质量的影响,为推动医保支付方式改革提供参考。方法:基于各地实践,从医疗服务能力、效率和质量三个维度,总结DRG/DIP付费的实施成效及局限性。结果:DRG付费在提升医疗服务能力和效率方面成效显著,但试点医院可能因成本控制压力而减少收治重症患者,或出现“低码高编”等不规范行为;DIP付费通过大数据分析实现医疗资源的优化配置,但在支持医疗技术创新方面存在局限性,或因分组标准与实际医疗资源消耗不匹配而面临挑战。结论:DRG/DIP付费各具优势与局限性,应融合两者优势,优化分组设计并加强信息化监管,实施差异化支付策略,从而全面提升医疗服务能力、效率、质量。
Objective To explore the impact of DRG/DIP payment on medical service capacity,efficiency,and quality,and to provide insights for advancing medical insurance payment reform.Methods Based on regional practices,the implementation outcomes and limitations of DRG/DIP payment were summarized from three dimensions of service capacity,efficiency,and quality.Results DRG payment achieved remarkable results in enhancing medical service capacity and efficiency.However,pilot hospitals might reduce admissions of critically ill patients due to cost control pressures or induce non-standard behaviors such as"changing low-code to high-grouping".DIP payment optimized resource allocation through big data analysis but faced limitations in supporting medical technology innovation and challenges from mismatches between grouping standards and actual resource consumption.Conclusion Both DRG and DIP payment possess distinct advantages and limitations.It is suggested to optimize the grouping design by combining the characteristics of both,strengthen information-based supervision,and implement differentiated payment strategies,so as to comprehensively improve medical service capacity,efficiency,and quality.
作者
郭萍
周明珠
吴庆艳
GUO Ping;ZHOU Mingzhu;WU Qingyan(School of Pharmaceutical Business,Guangdong Pharmaceutical University,Guangzhou Guangdong 510006,China;不详)
基金
广东省哲学社会科学规划2025年度一般项目“基于‘三医’协同的广东省医保支付改革综合绩效研究”(GD25CGG11)。
