摘要
医保支付模式是我国医保制度的重要环节,也是当前医改破解决“看病难、看病贵”重要途径。DRGs是国际社会公认的比较合理和科学的医保付费方式,已被确立为国家医保付费改革的重要方向。近年来,随着我国医疗改革政策的不断推进,国内开始推行疾病诊断相关组(Diagnosis Related Groups,DRG)的试点运行,到目前为止,国家医保局已在全国30多个城市组织开展DRGs付费试点运行。本文通过对目前上海DRGs的实施情况以及民众对DRGs付费方式的认知情况的了解,对DRGs付费方式的现状与产生的问题进行一一表述,就DRGs增加医务人员整体工作量,DRGs可能导致医院拒收疑难患者以及疾病编码和信息收集容易出错等方面有针对性地给出相应建议,进一步推动DRGs付费方式在我国的试点顺利运行。
The medical insurance payment model is an important part of China's medical insurance system,and it is also an important way for the current medical reform to solve the problem of"difficult and expensive medical treatment".DRGs is a more reasonable and scientific medical insurance payment method recognized by the international community,and have been established as an important direction of national medical insurance payment reform.In recent years,with the continuous advancement of China's medical reform policies,so far,the National Health Insurance Administration has organized the pilot operation of DRGs payment in more than 30 cities across the country.This paper introduces the relevant cases,current situation and problems of DRGs payment methods in Shanghai through case analysis and interviews,and gives relevant suggestions to further promote the smooth operation of DRGs payment methods in China.
作者
苏琦
杨雪芬芳
Qi Su;Fenfang YangXue(Shanghai University of Engineering Science,Shanghai,China)
