云南省某市DRGs试点现状及全面实施对策的研究分析

Research and Analysis on Current Situation of DRGs Pilot Program and Its Comprehensive Implementation Countermeasures in a City of Yunnan Province

目的 通过对云南省某市DRGs试点情况进行分析,对不同级别医院实施DRGs存在的问题进行预测并提出建议,为该市实施DRGs及开展精细化管理提供参考。方法 梳理云南省DRGs实施的背景、发展历程、现状与成效,结合当前深化医药卫生体制改革的政策背景,对DRGs试点医院运行指标进行分析,对不同级别、不同类型的医疗服务机构的医疗服务产出进行数据化对比。结果 云南省某市加入DRGs试点的二级以上医疗机构在医疗服务广度上均符合组数要求,在医疗服务产出上,三级综合医院优于二级综合医院、中医医院。在总体绩效排名上,三级综合医院优于二级综合医院、中医医院。结论 在全面深化医药卫生体制改革的政策背景下,各医院应清晰自身定位,优化病种结构,基于DRGs进一步激活医院绩效评价体系,实施医院全成本核算,形成成本和质量控制为中心的管理模式,提高医院的运行效率。

Objective: Based on the analysis of DRGs pilot situation in a city of Yunnan province,the problems existing in the implementation of DRGs in hospitals at different levels were predicted and suggestions were put forward to provide references for the implementation of DRGs and the development of fine management in this city. Method: By sorting out the background,development process,current situation and effect of DRGs implementation in Yunnan province,and combining with the current policy background of deepening the reform of medical and health system,this paper analyzes the operating indexes of DRGs pilot hospitals,and makes a data-based comparison of medical service output of medical service institutions of different levels and types. Result: In a city of Yunnan province,the secondary and above medical institutions participating in the DRGs pilot all meet the requirements of the number of groups in terms of the breadth of medical services.In terms of medical service output,the comprehensive hospitals of grade three are superior to the secondary comprehensive hospitals and traditional Chinese medicine hospitals.In the overall performance ranking,comprehensive hospitals of grade three are better than the secondary comprehensive hospitals and TCM hospitals. Conclusion: Under the policy background of comprehensively deepening the reform of medical and health system,each hospital should clarify its own positioning,optimize disease structure,further activate hospital performance evaluation system based on DRGs,implement the full cost accounting of the hospital,form a management mode centering on cost and quality control,and improve the operating efficiency of the hospital.