C-DRG收付费与按病种分值付费实践政策比较——基于福建省三明市和厦门市医保支付方式改革实践

Comparison of the Policy between Payment by C-DRG and Payment by Disease Score in Practice△——Based on the Reform Practice of Medical Insurance Payment Method in Sanming and Xiamen of Fujian Province

梳理福建省三明市C-DRG收付费和厦门市按病种分值付费的改革背景与发展历程,比较两者基本概念、适用范围、病组与标准形成机制、技术支撑、结算政策等实践情况,两者有较多的相同点,也有一定的差异,医保支付方式改革需尊重多元诉求、因地制宜,综合两者优势有利于推动医保支付方式改革。

This paper sorts out the reform background and development of payment by C-DRG in Sanming City and the payment by disease score in Xiamen,and compares their practice situations such as basic concepts,scope of application,diagnosis related group and standard formation mechanism,technical support,settlement policy. There were points of similarity and certain differences be tween them. The reform of medical insurance payment methods should respect multiple demands and adapt to local conditions. Combin ing their advantages helps promote the reform of medical insurance payment methods.