中国版疾病诊断相关分组的制定及在医疗保险中的应用探析

Establishment of the Chinese Diagnosis Related Group System(DRGs) and the Implementation in the Medical Insurance Payment System

疾病诊断相关分组(DRGs)被广泛证明应用于医疗保险支付制度中对控制医疗费用不合理的上涨具有重要的现实意义。文章在介绍DRGs在我国医疗保险领域的实践状况的基础上,结合国外经验,对制定中国版DRGs进行了探析,提出在医疗保险制度中实施DRGs支付方式的要点以及相关的解决对策,即通过规范疾病诊断和编码、制定临床诊疗规范、建立科学的病种成本核算系统和完善医疗质量监督机制,实现DRGs在我国医疗保险支付制度中的应用。

The implementation of Diagnosis Related Group System （DRGs） in the medical insurance payment system was approved of great importance to control the irrational increase of medical expenses nationally. Based on the introduction of the DRGs＇ application in the medical insurance system and referred to the international experience, the article analyzed the establishment of Chinese DRGs, and put forward some suggestions on the application of DRGs in the medical insurance payment system, namely normalizing the diagnosis＇ name and code, establishing clinical guidelines, setting up a DRGs cost account system and completing the medical quality supervision mechanism.