基于公立医院视角的DRG支付方式改革模拟运行结果分析

Analysis of the Simulation Results and Strategies of the DRG Payment Reform Based on the Perspective of Public Hospitals

目的分析武汉某公立医院2019年DRG支付方式改革模拟运行数据,探讨改革对医院运营管理带来的挑战并提出相应对策。方法对模拟运行数据进行定量分析。结果部分病组超支付标准较多,相关专科控费压力较大,医院经济运营、学科建设、疑难重症患者收治和新技术新业务开展面临挑战。结论公立医院应建立统一协调的应对DRG支付改革工作机制,加快DRG医保管理系统建设,提升运营管理综合效能,加强与医保管理部门沟通谈判,实现“医—保—患”三方共赢。

Objective By analyzing the simulation operation data of the Dignosis Related Groups(DRG)payment reform in a public hospital in Wuhan in 2019,it aims to explore the challenges brought by the hospital operation and management reform,and suggest corresponding effective countermeasures.Methods Quantitative analysis is applied to analyze simulated data.Results Average expenses of some DRG were higher than the payment standard,bringing relatively high pressure for those clinical specialties on controlling fees.Consequently,it brought all kinds of challenges to hospital economic operation,the disciplinary development,the treatment of severe diseases patients,and the application of new technologies.Conclusion Public hospitals should establish a unified and coordination mechanism to deal with the DRG payment reform,accelerate to setting up the DRG medical insurance management system,improve the comprehensive efficiency of its operation and management,strengthen the communication and negotiation with those healthcare security administrations,and eventually to reach the multi win-win situations of the“hospital-insurance-patient”.