DRGs在北京医保支付管理中的应用

Application of DRGs in Medical Insurance Management

本文采用描述性统计分析方法,就2011年以来在北京市医疗保险定额支付、总额预付中使用DRGs这一精细化管理工具的试点情况进行初步评估。该工具在医保管理中的有效应用将医保患三方的利益要求落实到每一个病例,使各方责任、权利、义务范围更加明确。基于试点分析的基础上建议医保经办机构需进一步完善管理体系,医疗机构需进一步改进绩效管理,改善服务流程,缩短结算周期。

By using the descriptive statistical analysis method, the pilot effect of using DGRs in fixed amount payments and total budget prepayment for the employee medical insurance in Beijing since 2011 was evaluated. The effective application of this method in medical insurance management has made the interests of three parties, i.e. hospitals, health insurance and patients, embodied on each case, and made the ranges of their responsibility, rights and obligations clearer. Based on above results, we suggest that medical insurance agencies need improve their management system, and medical institutions need improve performance management to enhance service process, and to shorten the settlement period.