“十三五”深化医疗体制改革期间我国疾病诊断相关分组付费支付方式改革进展及未来展望

Progress and future prospects of diagnosis-related groups in China during“the 13th Five-Year Plan”to deepen the reform of the medical system

“十三五”医疗体制改革期间,我国疾病诊断相关分组付费(DRG)支付方式改革取得显著性试点成果,先后出现8个主流DRG版本。国家医疗保障疾病诊断相关分组作为集大成者,初步形成了中国特色DRG付费体系,未来还需夯实编码体系助力分组方案完善,加强配套制度设计和评估体系建设。DIP付费将与DRG同步协调推进支付方式改革扩面。公立医院应有效开发利用DRG工具,强化成本意识,在医保管理、绩效管理、医疗管理、护理管理等方面协同发力,激发临床内生动力,以信息化为支撑,形成基于DRG的立体式医院管理体系。

During the“13th Five-Year Plan”period of medical reform,Chinese diagnosis-related groups(DRG)payment system reform achieved remarkable pilot results,and eight mainstream diagnosis-related groups(DRG)versions appeared successively.As a master,China healthcare security diagnosis related groups has initially formed a DRG payment system with Chinese characteristics.In the future,it needs to consolidate the coding system to help improve the grouping scheme,and strengthen the design of supporting system and the construction of evaluation system.DIP payment will coordinate with DRG to promote the reform and expansion of payment methods.Public hospitals should effectively develop and utilize DRG tools,strengthen cost awareness,and make concerted efforts in medical insurance management,performance management,medical management,nursing management,etc.,so as to stimulate clinical endogenous dynamics and form a DRG-based three-dimensional hospital management system supported by information technology.