德国社会医疗保险住院总额预算与DRG的衔接及其启示

The Connection between Total Inpatient Budget and DRG and Implications of German Social Medical Insurance

当前我国正在推进医保总额预算管理下多元复合式支付方式改革,对住院总额预算与按疾病诊断相关分组(DRG)、按病种分值付费(DIP)为主的多种结算方式的有效衔接提出了新的要求,德国采取的多元支付方式组合及其经验可为我国医保支付方式改革提供参考。文章聚焦德国社会医疗保险住院总额预算与DRG的衔接机制这一主题,通过介绍德国的总额预算实施的背景与概况、德国确定中央法定医疗保险基金预算、德国分配地方疾病基金预算、德国分配医院住院总额预算,并在相关研究基础上,重点探讨了德国社会医疗保险对我国住院支付方式改革的启示。

At present,China is promoting the reform of diversified and compound payment methods under the budget management of the total medical insurance amount,which puts forward new requirements for the effective connection between the total inpatient amount budget and multiple payment methods based on Diagnosis Related Groups(DRG) and Diagnosis-Intervention Packet(DIP).The combination of multiple payment methods adopted by Germany and its experience can provide reference for the reform of the medical insurance payment method in China.Focusing on the theme of the linkage mechanism between the total inpatient budget of German social medical insurance and DRG,the article introduces the background and overview of the implementation of the total budget in Germany,the determination of the central statutory medical insurance fund budget in Germany,the allocation of the local disease fund budget in Germany,and the allocation of the total inpatient budget in Germany.On the basis of relevant research,the article focuses on the enlightenment of German social medical insurance on the reform of China’s inpatient multiple payment methods.