DRG改革背景下负向医疗行为的成因分析及治理策略

Cause Analysis and Governance Strategy of Negative Medical Behaviors under the Background of DRG Reform

我国按疾病诊断相关分组支付方式改革过程中出现了诸如选择性收治患者、诱导住院等负向医疗行为,运用舞弊三角理论分析其成因发现,医疗机构在改革过程中面临的压力和医生自我合理化心态是诱发负向医疗行为的客观外因和主观内因;此外,改革过程中各利益相关主体信息不对称、法律法规不健全以及监管效能低下等,也是导致负向医疗行为的重要因素。针对压力、机会及自我合理化三方面,从减轻医生逐利压力、完善监督医疗行为的信息系统和法律法规、提高内外部监督效能、培养医德、营造医风氛围等方面,为改革提供合理建议。

Negative medical behaviors such as selective admission of patients and induced hospitalization have emerged in the process of diagnosis related group(DRG) payment reform in China. Analysis of their causes by applying the fraud triangle theory reveals that the pressure faced by medical institutions in the reform process and doctors’ self-rationalization mentality are the objective external and subjective internal factors that induce negative medical behaviors. In addition, information asymmetry among stakeholders, inadequate laws and regulations, and ineffective supervision are also important factors that lead to negative medical behavior. In terms of pressure, opportunity and self-rationalization, we provide reasonable suggestions for reform in terms of reducing the profit-seeking pressure on doctors, perfecting supervising information systems and related regulations,improving the effectiveness of internal and external supervision, cultivating medical ethics and strengthening medical mortality.