分级诊疗目标导向下DRG基础病组同病同价支付政策比较分析

Comparative Analysis of“Same Disease,Same Price”Policy in Diagnosis Related Group Payment Under the Goal of Tiered Healthcare Delivery

目的比较分析实施疾病诊断相关分组(diagnosis related group,DRG)支付方式改革地区的基础病组同病同价支付政策,为该政策的优化与推广提供参考建议。方法检索全国省级医疗保障局网站和190个实施DRG支付方式改革城市的医疗保障局网站,收集2019年1月1日—2024年5月31日其官网发布的DRG政策文件,应用Excel软件整理资料,采用比较分析法归纳总结基础病组政策的地区覆盖、医疗机构覆盖和病组覆盖现状。结果DRG基础病组同病同价支付政策覆盖地区数量少且不均衡,共16个省、2个直辖市及3个自治区的76个地市实施了该政策,占实施DRG付费城市总数的40%,且主要集中于东部地区。医疗机构覆盖面存在差异,大部分地区的基础病组政策覆盖所有级别的医疗机构,部分地区的基础病组政策主要在二级和三级医疗机构实施。病组遴选标准基本一致,以常见、多发,诊疗技术成熟、难度低和医疗费用稳定且差异小为主要纳入标准。地区间基础病组数量、权重和分布不均衡,纳入的基础病组数量为3~117不等,权重区间为0.16~1.57,以内科治疗为主,哮喘和高血压是最常见的基础病组。结论建议进一步扩展DRG基础病组同病同价支付政策覆盖的地区范围,因地制宜确定医疗机构覆盖范围,分阶段扩展病种覆盖范围,加强政策实施效果评价。

Objective To compare and analyze the“same disease,same price”policy in the regions implementing diagnosis related group(DRG)payment reform,and to provide recommendations for further policy optimization and extension.Methods DRG policies published on official website of healthcare security bureaus from all provinces and 190 cities between 1 January 2019 to 31 May 2024 were collected.Microsoft excel was applied to collect the information,and the comparative analysis method was used to summarize and analyze the DRG polices from three dimensions:region,healthcare facility,and disease groups coverage.Results The regions where the“same disease,same price”policy in DRG payment was implemented were limited and unevenly distributed.The policy has been implemented in 76 cities across 16 provinces,2 municipalities,and 3 autonomous regions,accounting for 40%of the cities implementing DRG payment.The pilot cities were mainly concentrated in eastern China.Coverage of healthcare facilities varied across regions.This policy covered all levels of healthcare institutions in most of the pilot cities,while it was primarily implemented in secondary and tertiary hospitals in some regions.The selection criteria for primary disease groups were generally consistent:the common diseases with mature diagnostic,treatment techniques and stable medical costs.However,the number,relative weight,and distribution of primary disease groups varied across regions,with the number ranging from 3 to 117 and relative weight ranging from 0.16 to 1.57.The primary diseases were mainly concentrated in internal diseases,with asthma and hypertension being the most common disease groups.Conclusion It is recommended to expand the scope of region coverage,determine the scope of hospital coverage according to local capacities,expand the scope of disease groups by stages,and evaluate the effect of policy implementation.