深圳市按病种分值付费改革经验与讨论

Experience and discussion on diagnosis intervention packet(DIP)reform in Shenzhen

目的:总结深圳市按病种分值付费(DIP)的改革经验和成效,为医保支付方式改革提供借鉴。方法:分析深圳市DIP改革的具体措施,对实施DIP前后医保基金的安全性、住院患者费用和具体病种费用情况进行对比,对政策实施产生的影响进行分析。结果:实施DIP后,2020年医保基金结余率有所提升,全市住院患者总费用比2019年降低2.98%。某具体病种自费病人总费用比DIP病人的总费用高16.85%,在总费用、平均住院日、检查占比和化验占比等方面高于DIP病人。结论:医保基金保持较好安全性,DIP对深圳市医保基金的结余率、住院患者总费用及控制过度检查产生了积极作用。DIP已成为主要结算方式,可建立病种分值动态调整机制,进一步提升病种库、病种分值同临床的契合性。

Objective:To summarize the experience of the reform of the Diagnosis Intervention Packet(DIP)in Shenzhen,and provide a reference for the reform of the medical insurance payment mode.Methods:The specific measures of DIP reform in Shenzhen were analyzed.The security of the medical insurance fund,the cost of inpatients,and the cost of specific diseases before and after the implementation of DIP were compared.The impact of the implementation of the policy was analyzed.Results:After the implementation of DIP,the balance rate of medical insurance funds in 2020 has increased,and the total expenses of inpatients in the city have decreased by 2.98%compared with 2019.The total expenses of self-paid patients for a specific disease were 16.85%higher than that of DIP patients,and higher than that of DIP patients in terms of total expenses,average length of stay,proportion of examinations,and laboratory tests.Conclusion:The medical insurance fund maintains good security.DIP has played a positive role in the balance rate of the medical insurance fund in Shenzhen,the total expenses of inpatients,and the control of over-examination.DIP has become the main settlement method,which can establish a dynamic adjustment mechanism for disease category score,and further improve the compatibility of disease category bank and disease category score with clinical practice.