我国医保支付方式改革对医疗机构医疗服务能力影响的系统评价

Systematic evaluation of the impact of China's reform of medical insurance payment on the medical service capacity of medical institutions

[目的]系统评价我国DRG/DIP支付方式改革对医疗机构医疗服务能力的实施效果。[方法]计算机检索PubMed、Embase、Web Of Science、CNKI、CBM、WanFang Data、VIP数据库,并按照纳入标准与排除标准,对所有通过搜索得到的文献进行甄别筛选,将符合研究的文献进行质量评价,采用主题综合法对纳入研究范围的文献进行综合分析,形成1个核心主题和3项评价指标。[结果]共纳入10篇文献研究,文献质量得分均为14分及以上,共计716,721例研究对象。系统评价结果显示,与未实施DRG/DIP组相比,实施DRG/DIP组的CMI值(P<0.05)、总权重上升,DRG组数增多。[结论]DRG/DIP支付制度的实施能够有效提升医疗机构医疗服务能力,但仍存在上升空间,应优化病案首页质量体系、发挥CMI指标评价作用、提升服务质量及患者满意度,以推动医疗机构长远发展。

Objective To systematically evaluate the effectiveness of China's DRG/DIP payment reform on the medical service capacity of medical institutions.Methods Databases including PubMed,Embase,Web of Science,CNKI,CBM,WanFang Data and VIP were retrieved,and all the retrieved literature were screened based on predefined inclusion and exclusion criteria.The quality evaluation of the literatures conforming to the research was carried out.Thematic synthesis was employed to make a comprehensive analysis of the literature included in the research scope,forming a core theme and three evaluation indicators.Results A total of ten studies were included,and the scores of literature quality were 14 or above,with a total of 716,721 subjects.The results of systematic evaluation showed that compared with the non-DRG/DIP group,the CMI value(P<0.05),the total weight and the number of DRG groups increased in the DRG/DIP group.Conclusions The implementation of DRG/DIP payment system can effectively improve the medical service capacity of medical institutions,but there is still room for improvement.It is imperative to optimize the quality system of the front page of medical records,give play to the evaluating function of CMI index,improve service quality and patient satisfaction,so as to promote the long-term development of medical institutions.