北京市病例组合定额付费(DRGs-PPS)试点阶段评价

The Evaluation of the Pilot Study on Diagnosis Related Groups and Prospective Payment System in Beijing

自2011年10月,北京市在全国率先实施按病种组合定额支付结算(DRGs-PPS)。本研究采集了2008年至2012年北京市职工医保病人出院病历数据,以6家试点医院为研究组,选择了8家与试点医院规模相当的医院作为对照。从便利性、患者可负担性、供方可负担性、保方可负担性、医疗质量、服务能力和服务效率等七个方面,对DRG-PPS的效果进行了初步分析。分析结果显示,试点方案可行、流程运行平稳,取得了医院收入不减、患者负担减轻、基金增长可控的初步成效。试点说明在北京实施DRGsPPS是可行的。

In October , 2011, Diagnosis Related Groups- Prospective Payment System？ DRGs-PPS？were initiated in Beijing. This paper used descriptive statistics method to compare the data of 108 groups of cases during the year of 2008 to 2012 in 6 pilot hospitals and 8 control hospitals, thus to evaluate the effectiveness of the pilot scheme. The main indices included case difficulty coefficient （CMI）, the statistics of item cost, settlement fees, insurance payment, personal burden, the average hospitalization days, two weeks re-hospitalization rate etc. It is concluded that the pilot scheme is feasible, the process was smoothly operated. After the initiation, it demonstrated that the hospital income did not reduce, while the patients’ burden was reduced, and the growth of fund was controllable, therefore the implementation of the DRGs-PPS in Beijing is feasible.