柳州DRG-点数法的政策机制、改革效果与核心经验

The Policy Mechanism,Reform Effect And Experience Summary Of Liuzhou DRGElative Value Scales For Disease

柳州于2017年7月1日从10家三级医院开始启动住院DRG-点数法付费方式改革,仅用半年时间就实现了DRG付费对所有区县、所有医疗机构和职工、居民医保的全覆盖。改革三年来,柳州形成了针对不同医疗服务特点的基金点数化分配模式,实现了医保基金扭亏为盈、医疗费用不合理增长得以控制、参保人就医负担明显下降、医疗机构运营管理绩效改善等一系列良好的政策改革效果。柳州样本的改革特点和核心经验在于其将DRG定价工具与基金点数分配方法相结合,并因地制宜地打造一套寓于管理全过程的“筹资(预算)-定价(DRG)-支付(点数法)-管理(运行机制)”的DRG付费政策机制,以提升医保基金的支付效率和精细化管理水平。

Liuzhou reformed the inpatient DRG-elative value scales for disease as the method of payment that started from 10 tertiary hospitals on July 1,2017.It only took half a year that realized DRG payment to achieve full coverage for all districts and counties,medical institutions,employees and residents medical insurance.In the past three years,Liuzhou has formed a point-based distribution model of funds for diff erent medical service characteristics.This model has obtained good eff ect of policy reform,which included the turnaround of the medical insurance fund,the increase in medical expenses,the signifi cant reduction in the medical burden of the insured,and the improvement in the operation and management performance of medical institutions.The characteristics and core experience of the Liuzhou sample’s reform indicates that it combines DRG pricing tools with fund point allocation methods.Moreover,it creates a comprehensive DRG payment policy mechanism which is“funding(budget)-pricing(DRG)-payment(elative value scales for disease)-management(operation)”based on local conditions to promote the refi ned management level of the medical insurance fund.