DRG支付方式改革下医院医保精细化管理研究的可视化分析

Visualization Analysis of Refined Management of Hospital Medical Insurance Research Under DRG Payment Reform

目的系统地分析国内外DRG支付方式改革背景下医院医保精细化管理领域的研究现况及热点问题,以期为我国DRG支付方式改革和医院医保精细化管理的推进提供新的视角与参考。方法以DRG支付方式改革为切入点,检索并筛选2009-2022年中国知网和Web of Science核心合集数据库中关于医院医保管理的文献,将结果信息以题录的形式运用Citespace 6.2.R4软件进行可视化分析。结果共纳入中文文献743篇、英文文献336篇。从发文文献上看,国内外文献总体的年发文量均呈持续上升趋势,且近年来国内文献年发文量虽高于国外,但文献质量整体较低;从发文机构上看,国内研究的创新性与深度还有待提升,机构间合作交流强度较弱,大多处于独立研究状态;在国内医院医保管理领域的突现词中,“成本管理”“病案首页”和“绩效管理”突现强度较高,提示“监测病案首页填写质量”“加强医疗资源的成本管理”和“开展以DRG为导向的绩效考核”是当前国内领域的热点问题;在国外研究的突现词中,“epidemiology(流行病学)”突变强度较高,提示研究将DRG及其衍生指标与流行病学更好地结合,是国外研究的热点前沿。结论国内外医院医保管理研究热点大体一致,但国内研究更强调DRG数据质量,建议加强病案首页的填写质量,同时构建DRG信息化平台,共促医院医保精细化管理。

Objective To systematically analyze the research status and hot issues in the field of refined management of hospital medical insurance under the background of DRG payment reform at home and abroad,in order to provide a new perspective and reference for the reform of DRG payment and the promotion of refined management of hospital medical insurance in China.Methods Taking the reform of DRG payment method as the starting point,the literature on hospital medical insurance management in the core collection database of CNKI and Web of Science from 2009 to 2022 was retrieved and screened,and the results were visualized and analyzed by Citespace 6.2.R4 software in the form of catalogue.Results A total of 743 Chinese literatures and 336 English literatures were included.From the perspective of published literature,the overall annual volume of domestic and foreign literature had continued to rise,and in recent years,although the annual volume of domestic literature was higher than that of foreign literature,the overall quality of literature was low.From the perspective of publishing institutions,the innovation and depth of domestic research need to be improved,the intensity of inter-agency cooperation and exchange was weak,and most of them were in an independent research state.Among the burst words in the field of medical insurance management in domestic hospitals,“cost management”“front page of medical records”and“performance management”had a high intensity burst,suggesting that“monitoring the quality of filling in the front page of medical records”“strengthening the cost management of medical resources”and“carrying out DRG-oriented performance appraisal”were hot issues in the current domestic field.Among the burst words of foreign research,the mutation intensity of“epidemiology”was higher,suggesting that the research combines DRG and its derivative indicators with epidemiology better,which was a hot frontier of foreign research.Conclusion The research hotspots of hospital medical insurance management at home and abroad are generally the same,but the domestic research emphasizes the quality of DRG data.It is suggested to strengthen the quality of filling in the front page of medical records,and construct DRG information platform to promote the fine management of hospital medical insurance.