基于PMC指数模型的我国按疾病诊断相关分组付费政策量化评价

Quantitative evaluation for payment policy of diagnosis-related groups in China based on PMC index model

目的对我国现有的按疾病诊断相关分组(DRGs)付费政策进行量化评价,为政策的制定和完善提供参考。方法采用文本挖掘法对2017-2022年国家和各省级医疗保障局发布的58份与DRGs付费相关的政策文件进行处理,建立DRGs付费政策PMC指数评价模型,并通过10个一级变量和40个二级变量对9项典型DRGs付费政策进行量化评价分析。结果在9项政策中,优秀级5项,可接受级4项,PMC指数平均值为6.882,总体处于可接受水平,但仍有较大改进空间。通过对比2项代表性政策发现,其中1项PMC指数平均值较低的主要原因为受限于城市发展水平,从而在面临政策转变时对监督管理、激励约束两方面的考虑有所欠缺。结论目前我国DRGs付费政策框架已基本成形,可从延长政策时效、总结推广试点城市的成功经验等方面进一步完善。

OBJECTIVE To quantitatively evaluate the existing payment policies of diagnosis-related groups(DRGs)in China,so as to provide reference for the formulation and improvement of policies.METHODS Totally 58 documents related to DRGs payment issued by the national and provincial medical security bureaus from 2017 to 2022 were processed by text mining method.PMC index evaluation model of DRGs payment policy was established.Nine typical DRGs payment policies were quantitatively evaluated and analyzed by 10 primary variables and 40 secondary variables.RESULTS Among the 9 policies,5 were excellent and 4 were acceptable.The average score of PMC index was 6.882.Generally,there was still room for improvement because of the acceptable level.By comparing the two representative policies,it was found that the main reasons was a lack of consideration in terms of supervision and management,incentives and constraints when facing policy changes,reason of the lower level of urban development.CONCLUSIONS Although DRGs payment policy in China is basically perfect,there is still a lot of room for improvement in terms of extending the time limit of the policy,summarizing and spreading the successful experience of pilot cities.