DIP支付方式改革背景下医疗机构精细化管理的探讨

Discussion on Fine Management of Medical Institutions Under the Background of DIP Payment Reform

随着近年来我国医改的不断深化,按病种分值付费(diagnosis-intervention packet,DIP)支付方式的逐步推广普及,为医院医保得以形成精细化管理模式提供了有力参考依据。DIP支付方式本身对促进医疗技术创新、强化医疗诊治能力、加快医院高质量发展有着不可取代的积极作用,同时这也是医保效能可以得到充分发挥的基础条件。实践期间主要是将统筹地区医保总额预算与点数法相结合,实现住院以DIP为主的多元复合支付方式。建立起现代化的数据治理机制,形成数据采集、存储、使用的规范和标准。逐步建立以病种为基本单元,以结果为导向的医疗服务付费体系,完善医保与医疗机构的沟通谈判机制。加强基于病种的量化评估,使医疗行为可量化、可比较。形成可借鉴、可复制、可推广的经验,为下一步在更大范围推广打好基础。文章将对DIP支付方式改革背景下医院医保精细化管理进行全面分析,并结合实际做好相应整理和总结。

With the deepening of China’s medical reform in recent years,the gradual popularization of diagnosis-intervention packet(DIP)payment method provides a strong reference for the formation of a refined management model for hospital medical insurance.DIP payment itself has an irreplaceable positive role in promoting medical technology innovation,strengthening medical diagnosis and treatment capabilities,and accelerating the high-quality development of hospitals,and this is also the basic condition for medical insurance efficiency to be fully exerted.During the practice period,the total regional medical insurance budget was mainly combined with the point method to realize a diversified compound payment method based on the value of the disease.Establish a modern data governance mechanism and form norms and standards for data collection,storage and use.Gradually establish a resultsoriented medical service payment system with the type of disease as the basic unit,and improve the communication and negotiation mechanism between medical insurance and medical institutions.Strengthen quantitative assessment based on disease types to make medical behaviors quantifiable and comparable.Form experiences that can be referenced,replicated and promoted,and lay a good foundation for the next step of wider promotion.This paper will comprehensively analyze the refined management of hospital medical insurance under the background of DIP payment method reform,and organize and summarize it accordingly based on the actual situation.