DRG高倍率病例现状与政策优化思考

Current Situation and Policy Optimization of DRG High-Rate Cases

以四川省眉山市为例,通过现状分析,发现DRG高倍率筛选机制不合理,医院的病案编码能力和医疗服务能力不足,存在道德风险,低权重病例更易产生高倍率等问题。为了实现合理补偿,鼓励新技术发展,提出相应建议:探索建立权重与费用相结合的筛选机制、靶点监管机制和退费机制,协同高倍率政策的审核和特病单议机制,提高医院的病案编码能力和医疗服务能力,规范执行临床路径。

Taking Meishan City, Sichuan Province as an example, this study analyzed the current situation of DRG high-rated cases.This study found that the screening mechanism of DRG high-rate cases was unreasonable, and the hospital’s medical record coding ability and medical service ability were insufficient. It was likely to appear moral hazard, and high-rate problem was more possible to happen in low-weight cases. In order to achieve reasonable compensation and encourage the development of new technologies, it is suggested to explore the establishment of a screening mechanism combining weights and costs, a target monitoring mechanism, a refund mechanism, an audit mechanism which coordinates with high-rate policies, and a mechanism of specific discussion on special diseases. Hospitals should improve the ability of medical record coding and medical service, and standardize the implementation of clinical paths.