南京DRG点数法付费在中医医院的实施效果及其完善策略探析——以某省三甲中医院为例

Analysis of the Implementation Effect of Nanjing DRG Point Payment Method in Chinese Medicine Hospitals Sampled with One Third Class Chinese Medicine Hospital

目的:分析医院实施DRG后对经济运营、医疗服务供给等方面的影响,为推进符合中医药特点的医保支付方式改革提供策略建议。方法:以南京市DRG点数法付费为例,从医院DRG病组、中医DRG病组和科室病组3个层面与全市进行横向比较,从医疗服务能力、医疗质量和医疗成本等维度与医院去年同期水平进行对比分析。结果:医院实施点数法付费后,存在中医病种组数覆盖面相对不足,中医特色明显科室DRG亏损相对明显,中医药特色优势发挥不显著等问题。结论:医院能够快速适应DRG点数法付费改革,在总体运行情况较好的情况下,仍然要加强对中医医保政策和中医病种入组等方面的研究,通过推行中西医结合多学科诊疗模式、统筹协调“绩效考核与医保支付”等措施,实现在DRG点数法付费下中医药特色优势得到充分发挥。

Objective To analyze the influence of DRG on economic operation,medical service supply and other aspects of hospitals,so as to provide strategic suggestions for promoting the reform of medical insurance payment mode in line with the characteristics of Chinese medicine.Methods Taking Nanjing DRG point payment method as an example,a horizontal comparison was made among the hospital DRG disease group,Chinese medicine DRG disease group,department disease group and the city,and a comparative analysis was made to the level of the same period last year from the dimensions of medical service capacity,medical quality,and medical cost.Results After the implementation of point payment method in hospitals of Nanjing,there were some problems such as the relatively insufficient coverage of the number of Chinese medicine disease groups,relatively obvious loss of DRG in departments with obvious Chinese medicine characteristics,and the insignificant play of the advantages of Chinese medicine characteristics.Conclusion The hospital can quickly adapt to the reform of DRG point payment method.Under the overall good operation condition,it is still necessary to strengthen the research on medical insurance policy of traditional Chinese medicine and the classification of traditional Chinese medicine diseases.Through the implementation of multidisciplinary diagnosis and treatment mode of combining traditional Chinese medicine with western medicine,and the overall coordination of“performance assessment and medical insurance payment”,the characteristic advantages of traditional Chinese medicine under DRG point payment method can be fully exerted.