GHS-DRG付费模式在肿瘤专科医院的实践与思考

Practice and Reflection on GHS-DRG Payment Model in Tumor Specialized Hospitals

目的分析GHS-DRG付费模式下某肿瘤专科医院入组恶性增生性疾患的靶向、免疫治疗(RG1)组的数据,探讨该组权重的合理性以及国家谈判药的医保支付问题。方法对2021年11月至2022年3月入组到RG1组病例数据进行描述性分析。结果按DRG付费对比项目付费,RG1组5个月减收278.50万元;住院费用中主要为药品费,占比达73.8%。结论RG1组按照当前权重医疗机构减收较多,各DRG组权重应建立动态调整机制。支付方式改革,要充分考虑国家谈判药的影响,国家谈判药品应单独进行支付,确保国家谈判药品政策落地实施。

Objective:To analyze the targeted and immunotherapy(RG1)group data of malignant proliferative diseases enrolled in a certain tumor specialized hospital under the GHS-DRG payment model,explore the rationality of the weight of this group,and discuss the issue of medical insurance payment for national negotiated drugs.Method:A descriptive analysis was conducted on the data of cases enrolled in the RG1 group from November 2021 to March 2022.Result:According to the DRG payment comparison project,RG1 group received a 5-month reduction of 2.785 million yuan;The main cost of hospitalization is drug expenses,accounting for 73.8%.Conclusion:According to the current weight,medical institutions in RG1 group have significantly reduced their income,and dynamic adjustment mechanisms should be established for the weights of each DRG group.The reform of payment methods should fully consider the impact of national negotiated drugs,which should be paid separately to ensure the implementation of national negotiated drug policies.