医保体系改革视角下基层医院按病种收付费改革的实证研究——基于湖南省县级医院的考察

An Empirical Study on the Reform of Basic-level Hospitals Based on DRGs from the Perspective of Health Insurance System Reform

按病种收付费在一定程度上解决了看病难、看病贵问题,缓解了医疗费用过快增长的压力,有助于医院收费趋于合理化.但收付费用改革在基层医院实施的情况怎样呢?论文以湖南省县级三级甲等医院为观察点,对按病种收付费在湖南省基层医院实施的具体情况、存在问题进行实证研究.结果表明:(1)部分病种的住院治疗时间有所缩短;(2)部分病种的治疗总费用有所降低,且药品费占比下降.(3)部分病种的治疗成本高于经核定的病种收费标准.为更快更好地推动按病种收付费改革,要从加强医院和监管机构的质量监管,以及强化政府责任,完善医院管理机制等方面着手.

To some extent,payment by disease has solved the problems of difficulty and high cost of medical treatment,relieved the pressure of rapid growth of medical expenses,and helped to rationalize hospital charges.However,how is the implementation of the reform of collection and payment of expenses in primary hospitals?This paper takes the county-level third-class and first-class hospitals in Hunan province as the observation point,and makes an empirical study on the specific situation and existing problems of implementing DRGs in primary hospitals in Hunan province.The results showed that:(1)hospitalization time for some diseases was shortened;(2)The total cost of treatment for some diseases has decreased,and the proportion of drug costs has decreased.(3)The treatment cost of some diseases is higher than the approved charging standard for diseases.In order to promote the reform of DRGs payment faster and better,we should strengthen the quality supervision of hospitals and regulatory agencies,as well as strengthen government responsibility and improve hospital management mechanism.