我国按病种分值付费(DIP)政策研究——基于国家、省、市三级的比较分析

Research on the policy of Diagnosis-Intervention Packet (DIP) in China: A comparative analysis based on the national, provincial and municipal levels

目的:比较国家、省、市三级按病种分值付费(Diagnosis-Intervention Packet, DIP)政策的共性与差异,为各省市的政策设计提供参考建议。方法:检索政府官网、北大法宝法律数据库系统收集国家及各省市有关DIP的政策文本,在文献资料和访谈资料分析的基础上,采用内容分析法进行提炼总结。结果:自2020年至今,国家医疗保障局共出台7份政策文件推进DIP支付方式改革,随后我国8个省份、7个地级市发布了相关政策文件26份。各省市的DIP政策适用范围与国家要求基本保持一致;在国家顶层设计的指导下,各地根据实际对关键要素设计(病种目录、分值、医疗机构系数)、监督管理措施等方面进行了调整与细化;病种分值方面,国家及多数省市均以历史数据为基准测算,但测算依据并不一致,不少地区要求考虑各病种间的相对权重。结论:地方政府及相关部门应出台指导性政策文件推进当地DIP改革,在设计政策时明确政策适用范围,建立关键要素动态调整机制,加强对医疗行为的监管并重视DIP在推进分级诊疗方面的作用。

Objective: Our study compared the similarities and differences of the national-provincial-municipal three-level DIP policy, in order to provide reference suggestions for the policy design of other cities.Methods: We collected the policy texts related to DIP in national and different regions from the official website of the government and the Peking University’s Fabao Law Database.Based on the analysis of literature and interview data, the content analysis method was used to refine and summarize.Results: Since 2020, the National Healthcare Security Administration has issued 7 policy documents to promote the reform of DIP payment method, and then 8 provinces and 7 prefecture level cities have issued 26 relevant policy documents.The scope of application of DIP policies in all provinces and cities was basically consistent with national requirements.Under the guidance of the national top-level design, all localities have adjusted and refined the design of key elements(disease directory, score, medical institution coefficient) and supervision measures according to the actual medical conditions.In terms of disease score, the country and most cities used historical data as the benchmark, but the calculation basis was not consistent.Many regions require to consider the relative weight of each disease.Conclusions: Local governments and relevant departments should issue guiding policy documents to promote local DIP reform;define the scope of policy application when designing policies;establish a dynamic adjustment mechanism for key elements;strengthen the supervision of medical behavior, and pay attention to the role of DIP in promoting hierarchical diagnosis and treatment.