本土化DRGs在医院管理中的应用及存在问题

Application and exiting problems of grouping DRGs localization during the progress of hospital management

DRGs在国外主要应用于医疗保险支付领域,目前在国内北京地区进行了部分医院的试点,但由于疾病编码不统一、病案首页质量等问题,尚没有在全国进行大范围的推广。但DRGs在医院管理中的作用逐步凸显,很多医院将DRGs技术应用于绩效考核、医院绩效服务评价、重点专科管理等方面。本文以某省三甲医院为例,首先介绍了该院DRGs分组器内部结构,然后结合该院应用现状,以及在应用过程中存在的问题,对DRGs的工作提出了几点意见,包括:编码的本土化、医保经办机构尽快探索医保支付方式、临床医师的积极参与等。

DRGs are mainly applied in the fi eld of medical insurance payment in foreign countries.At present,some hospitals in Beijing have been piloted in China.However,due to problems such as inconsistent disease coding and quality of the fi rst page of medical records,they have not been widely promoted in China.However,DRGs have been playing an increasingly prominent role in hospital management.Many hospitals apply DRGs technology to performance assessment,hospital performance service evaluation and key specialty management.Based on province 3 armour hospital as an example,this paper fi rst introduces the internal structure for the hospital DRGs grouping,and then combined with its application status,and the problems in the application process,puts forward some opinions of DRGs work,including:the localization of coding,insurance agency orgnaization to explore the medical insurance payment as soon as possible,the clinician to actively participate in and so on.