DRG收付费政策设计与实施中的经验及启示

The Experience and Enlightenment of DRG Pricing and Payment Policy Design and Implementation

医保支付方式改革在卫生系统改革中起着重要作用。DRG支付方式在医疗改革中可以视作杠杆,激发医疗机构规范行为,控制成本的内生动力。文章以三明C-DRG收付费改革为例,介绍了政策设计之初考虑的重点,将DRG作为撬动医疗卫生综合改革的一个工具,将收付费一体化,并引入成本定价。在政策设计与实施时,除了注重DRG自身相关技术问题以外,同时注重与当地改革与实际相结合,以问题为导向,制定相应政策,并考虑到DRG可能会引起的非预期行为和结果,逐步完善监管的内容。

The provider payment method reform plays an important role in the health system reform.The DRG payment method can be regarded as a lever in the health system reform to stimulate the endogenous motivation of medical institutions to regulate their behavior and control costs.Taking C-DRG pricing and payment reform in Sanming City as an example,it introduced key considerations at the beginning of the policy design.DRG will be used as one of several tools to instigate comprehensive health reforms,integrating pricing and payment,and introducing costing tool for better pricing.In the design and implementation,in addition to focusing on DRG’s own related technical issues,it also focused on integrating local reforms and actual issues to be addressed,and formulating corresponding policies based on the problems,taking into account the unexpected behaviors and results that DRG may cause,and gradually improving the content of supervision.