基于疗效评价探究DIP对医生诊疗行为的影响

Exploring the Impact of DIP on Physicians’Treatment Behavior Based on Efficacy Evalu⁃ation

目的:探索按病种分值付费方式改革对三甲公立医院医生医疗行为的影响,为医院更快、更好适应医保付费模式改革提供建议。方法:采用问卷调查及回顾性分析方法,对临床医生的医疗行为和看法进行分析。收集分析该院DIP付费改革前(2023年6月)和改革后(7月)带状疱疹病历各50份。结果:改革前后的异地就医情况、检查费用、药物费用、治疗效果、住院天数等医疗行为无显著差异;问卷调查结果显示临床医生对按病种分值付费改革的认知度与认可度有待加强,需要开展针对性培训。结论:医保部门应考虑建立复杂病例付费模式;医院应加强编码人员以及临床医疗工作者的相关培训,提升病案质量及填写规范,增强对医保付费改革的认知度与认可度;卫生部门应加强医保支付与医疗行为的监管。

Objective:Through retrospective analysis and questionnaire survey,to explore the influence of the reform of payment by disease score on the medical behavior of public top three doctors,and to provide suggestions for hospitals to adapt to the reform of medi-cal insurance payment model faster and better.Methods:Questionnaire survey and retrospective analysis were used to analyze the medical behavior and views of clinicians.We collected 100 medical records of herpes zoster in June and July,2023.In June,50 medi-cal records were before the reform of DIP payment,and in July,50 medical records were after the reform of DIP payment.Results:We found that there was no obvious difference in medical behavior after the reform of medical insurance payment methods by reviewing the medical treatment in different places,examination fees,drug fees,treatment effects and hospitalization days before and after the reform.The results of the questionnaire survey show that clinicians’awareness and recognition of the reform of payment by disease need to be strengthened,and training needs to be carried out to solve their problems.Suggestion:The medical insurance department should con-sider establishing a payment model for complex cases;Hospitals should strengthen the training of coding personnel and clinical medi-cal workers,improve the quality of medical records and fill in the norms,and enhance the awareness and recognition of the reform of medical insurance payment;In addition,the health department should strengthen the supervision system of medical insurance payment and medical behavior.