价值医疗视角下中医医院DRG综合运营管理方案探索

Preliminary Study on the Comprehensive Operation Management Scheme of DRG in Traditional Chinese Medicine Hospital from the Perspective of Value Medicine

目的:通过对价值医疗深层次涵义的阐述,提出价值医疗在中医专科DRG的实现路径,从而构建中医院DRG综合运营管理方案。方法:以文献归纳和案例研究相结合,以样本医院的肛肠病中医序列病种为例演绎以价值为导向的中医医院DRG综合运营管理方案。结果:建立符合中医诊疗服务特点的肛肠病种中医序列的DRG评价与入组标准,并在此基础上进行中医医院整体运营DRG解决方案的探索。结论:DRG整体运营管理方案是中医院顺应价值医疗发展趋势,实现从粗放式到精耕细作式管理模式转型的必然选择,同时,应当充分考量中医特色专病DRG的个性化差异,完善中医药成本控制及入组技术衡量标准,促进医保对中医药医疗资源的科学支付及合理配置。

Objective:By expounding the deep meaning of value medicine,it puts forward the realization path of value medicine in Diagnosis Related Group(DRG)of traditional Chinese medicine specialty,so as to construct the comprehensive operation and management scheme of DRG in traditional Chinese medicine hospitals.Methods:Based on literature review and case study,the value oriented DRG comprehensive operation and management scheme was deduced by taking the TCM sequence diseases of anorectal diseases in Nanjing Hospital of traditional Chinese medicine as an example.Results:The DRG evaluation and inclusion criteria of TCM sequences of anorectal diseases were established according to the characteristics of TCM diagnosis and treatment services,and the DRG solutions for the overall operation of TCM hospitals were explored.Conclusion:The overall operation and management scheme of DRG was an inevitable choice for hospitals to comply with the development trend of value-based medicine and realize the transformation from extensive management to intensive management.Meanwhile,it was necessary to fully consider the individual differences of DRG with special characteristics of traditional Chinese medicine,improve the cost control of traditional Chinese medicine and the technical measurement standards for its inclusion,and promote the scientific payment and rational allocation of medical resources of traditional Chinese medicine by medical insurance.