DRG支付方式对公立医院高质量发展的影响

The Impact of the DRG Payment System on the High⁃quality Development of Public Hospitals

“十四五”期间,我国公立医院进入高质量发展阶段,医保支付方式改革成为促进公立医院高质量发展的关键举措。然而,从目前情况来看,尽管疾病诊断相关分组(diagnosis related group,DRG)支付方式改革在缩短平均住院日、提高难度系数、降低中低风险病组死亡率方面取得了一定成绩,但也存在着配套政策不完善、分类系统需更新、病案首页质量参差不齐、编码质量急需提高,以及如何处理新技术的使用等诸多问题与挑战。因此,重新审视DRG支付方式对公立医院高质量发展的影响,不仅有助于更加清晰地认识当前所面临的困境,还能为未来进一步完善和优化医保支付方式提供重要参考依据。

During the 14th Five⁃Year Plan period,public hospitals in China have entered a phase of high⁃quality development,with health insurance payment system reforms becoming a crucial means to promote this advancement.However,from the current situation,although the diagnosis related group(DRG)payment reform has made great achievements in shortening the average length of stay,improving the case⁃mix index,and reducing the mortality rate of low⁃risk groups,there are also many problems and challenges such as incomplete supporting policies,the classification system needs to be updated,the quality of medical record home pages varies,the quality of coding urgently needs to be improved,and how to deal with the use of new technologies.Thus,revisiting the impact of the DRG payment method on the high⁃quality development of public hospitals will not only help to understand the current challenges more clearly,but also offer valuable insights for further improving and optimizing the payment method of health insurance in the future.