DRG支付背景下某公立医院专科建设思考及实施效果分析

Reflections and analysis of specialty construction in a public hospital in the context of DRG payment

近年来,随着医改的持续深化,按疾病诊断相关分组(DRG)支付逐渐成为新医改的焦点。DRG支付制度不仅是医保结付的方式,同时也是公立医院规范医生诊疗行为、衡量医疗服务质量的管理工具,促使医院由粗放管理转向精细管理转型,对公立医院的运营管理理念提出一系列挑战。因此,分析DRG支付方式改革给公立医院带来的影响以及相关运营情况意义重大。笔者选取某公立医院推进DRG支付方式改革以来的22 791例病案资料进行分析,探讨在DRG支付背景下医院运营的应对策略及主要问题,为公立医院更好地落实DRG支付政策及高质量发展转型提供建议。

In recent years,with the continuous deepening of healthcare reform,the Diagnosis-Related Group(DRG)payment method has gradually become a focal point of the new healthcare reform.The DRG payment system is not merely a mode of medical insurance reimbursement but also serves as a management tool for public hospitals to standardize physicians'diagnostic and treatment behaviors and assess the quality of medical services.This shift promotes hospitals to transition from extensive to precise management,posing a series of challenges to the operational and management philosophies of public hospitals.Thus,analyzing the impact of the DRG payment reform on public hospitals and the related operational circumstances is of great significance.This study analyzes 22,791 medical records from a public hospital following the implementation of the DRG payment reform,discusses the hospital's operational strategies and main issues within the DRG payment context,and provides suggestions for public hospitals to better implement the DRG payment policy and achieve high-quality development.