DRGs与DIP的对比研究:基于医院运营的视角

DRGs vs.DIP:From the perspective of hospital operations management

打包预付方式将控制医疗费用的责任转移至医方,能激励医院做好成本管控,会对医院的日常运营产生重大影响.本文主要研究按疾病相关组付费(DRGs)和按病种分值付费(DIP)两种支付方式,通过构建排队和竞争博弈模型探讨两种支付方式下的医院间服务速率决策问题以及相同医疗预算下的医疗服务质量、医院利润和社会福利的对比研究,并通过数值方式探讨了医院数量和服务成本系数对系统性能的影响.研究发现:1)DIP与DRGs相比,医院的服务速率相对降低,服务的病人数量较少,但医院利润更大.2)从社会福利来看,患者损失的成本较高时,DRGs较优;反之,DIP较优,且此时DIP是帕累托改进策略.3)只有当医院数量适中、服务成本系数较大时,DIP的优势才更明显.

The packaged payment will have a significant impact on the daily operation of hospitals since it moti-vates hospitals to pay more attention to cost control by transferring the responsibility of controlling medical ex-penses to doctors and hospitals.This paper mainly studies two payment methods,namely,DRGs and DIP.By constructing a queuing-based game model,the service rate competition between multiple homogeneous hospi-tals is studied under these two payments and medical quality,hospitals'profit and social welfare are compared under the same medical budgets.In addition,the impacts of the number of hospitals and service cost coeffi-cients on the system performance are studied with a numerical case.The paper finds that,compared with DRGs,the service rate is relatively lower,the number of patients served is relatively small,but hospitals'profit is greater under DIP.Second,from the perspective of payer,DRGs is better when the cost of patient loss is higher;otherwise,DIP is better and is a Pareto improvement strategy.Third,the advantages of DIP are more obvious when the number of hospitals is moderate and the service cost coefficient is large.