DRG付费模式下低码高编行为的分析与探讨

Analysis and Discussion on Upcoding Under DRG Payment Mode

低码高编行为是各国在探索DRG支付改革道路上面临的棘手问题,也是我国在探索DRG支付模式并确保其在医疗支付改革持续良性运行中亟待克服的严峻挑战。文章从低码高编行为的发生机制、内涵界定、潜在风险等多个维度进行阐述,并结合我国医保支付制度改革现况,提出一些建议,期望引起各医疗机构以及监管部门对低码高编现象的关注,为DRG支付改革的可持续运行保驾护航。

Upcoding is a thorny problem faced by all countries in exploring the progress of DRG payment reform,and it is also a severe challenge to be overcome in China's exploration of DRG payment mode and ensure its continuous and healthy operation in medical payment reform.This article elaborates on the mechanism,connotation definition,potential risks and other dimensions of upcoding,and combines with the current situation of China's medical insurance payment system reform,puts forward some suggestions,hoping to attract the attention of medical institutions and regulatory authorities to the phenomenon of upcoding,and escort the sustainable operation of DRG payment reform.