DRG改革背景下的负向医疗行为及其治理路径

Negative medical behavior and its governance path under the background of DRG payment reform

本着降低群众看病成本、提升医疗服务质量的初衷,DRG支付方式改革在国内不断推进和实施,在达致规范医疗行为、优化临床路径、落实分级诊疗等方面目标的同时,也因行业压力传导、主体信息错位、监管机制不足等因素,导致医院及医疗工作者出现病患推诿、质量降低、需求诱导、低码高编等负向医疗行为,不利于DRG支付方式原有效能的发挥。对此,应进一步提升DRG支付管理的规范性、强化信息化平台监测体系、优化医院运营管理模式,以更好的维护患者、医院、医保等多方的正当权益,不断促进医药卫生行业健康发展。

With the original intention of reducing the cost of medical treatment for the public and improving the quality of medical services,the reform of DRG payment system has been continuously promoted and implemented in China.While achieving the goals of standardizing medical behaviors,optimizing clinical pathways,and implementing graded diagnosis and treatment,there were still negative medical behaviors,which included patient shifting,reduced quality,demand induction,and deliberate diversion of patients into costly disease groups,among hospitals and medical workers due to factors such as industry pressure transmission,misaligned subject information,and insufficient regulatory mechanisms.Such is not conducive to the original effectiveness of DRG payment system.Therefore,it is necessary to further enhance the standardization of DRG payment management,strengthen the information platform monitoring system,optimize the hospital operation and management mode,so as to better safeguard the legitimate rights and interests of patients,hospitals,medical insurance institutions and other parties,and continuously promote the healthy development of the pharmaceutical and healthcare industry.