美国DRG下高值创新医疗技术的支付政策及启示

The Payment Policy and Enlightenment of High-value Innovative Medical Technology under DRG in the United States

本文系统总结了美国在MS-DRG支付系统下,针对高值创新医疗技术支付的改革与经验。具体总结了其对高值创新医疗技术的长期支付机制与短期支付机制下的新技术附加支付、异常值支付和共同支付政策。以期为我国在推进医保支付方式改革、促进医疗费用科学使用的同时,探索建立兼顾医学进步、高值创新医疗技术合理应用与推广的激励机制提供参考。

This paper systematically summarizes the reform and experience of high-value innovative medical technology payment under the MS-DRG payment system in the United States. It specifically summarizes its long-term payment mechanism for high-value innovative medical technology and new technology additional payment, abnormal value payment and co-payment policies under the short-term payment mechanism. It is expected to provide a reference for China to explore and establish an incentive mechanism that takes into account medical advancement and the rational application and promotion of high-value innovative medical technologies while promoting the reform of medical insurance payment methods and the scientific use of medical expenses.