关于省内异地就医纳入DRG付费的必要性及可行性研究

Necessity and Feasibility Study on the Inclusion of DRG Payment for Medical Treatment in Other Places In a Province

目的:对比分析山东省内异地就医情况,考察异地就医纳入DRG付费的必要性和可行性。方法:基于CHSDRG1.1版本分组器,将山东省内异地就医病例流入流出情况、异地就医与本地就医费用差异对比情况进行评价分析。结果:省内异地就医集中现象明显,病例以轻症为主,且省内异地就医费用明显高于本地就医。结论:加大对省内异地就医费用管理力度,将省内异地就医纳入就医地DRG付费和审核监管。推行同城同病同价,引导低权重病例向参保地回流、向县级及以下医疗机构下沉,提升医保基金使用效能。

Objective: The paper compares medical treatment in other places in Shandong Province, and explores the necessity and feasibility of including medical treatment in other places into DRG payment. Methods: Based on the CHS-DRG 1.1 version grouper, the inflow and outflow of cases in other places of Shandong Province, and the difference between the cost of medical treatment in other places and local area were evaluated and analyzed. Results:The concentration of medical treatment within the province is obvious, the medical treatment within the province is mainly for minor diseases, and the cost of medical treatment in other places within the province is significantly higher than that of local medical treatment. Conclusion: The government should enhance the management of medical treatment cost in other places within the province, and integrate the medical treatment in other places within the province into the DRG payment and supervision of the medical treatment place. Also, it was suggested to implement the same price for the same disease in the same city, guiding the return of low-weight cases to the place of participation and medical institutions at the county level and below, and improving the effectiveness of medical insurance funds.