DRG与DIP的本质、异同与实践影响

The essence,similarities and differences of DRG and DIP and their practical influences

DIP与DRG都是以临床实践中的诊断ICD-10和操作ICD-10-CM为基础进行的疾病分组,二者有着按病例支付的共性,差异是由于诊断和操作的颗粒度不同,导致了疾病分组的数量和病组间的差异性大小不同,对临床医疗行为、医疗管理和医保基金分配的影响不同。通过部分地区的实证数据比较发现,DRG支付更有利于医疗机构的补偿和控制不合理的医疗行为。对标美国、欧洲各国和日本的DRG分组的历史发展与演变,研判中国DRG和DIP分组的相对位置,为我国医保支付方式改革实践提供思路。

Both DIP and DRG are tools of disease classification based on ICD-10 for diagnosis and ICD-10-CM for clinical procedure,and they share the commonality of case-based payment.The difference is that the granularity of diagnosis and operation is different,resulting in different numbers of disease groups and differences between disease groups,and the different impacts on clinical behaviors,medical management and the allocation of health insurance funds.Through the comparison of empirical data in some regions,it is found that DRG payment is more conducive to the compensation and control of unreasonable medical behaviors in health facilities.By comparing the historical development and evolution of DRG groups in the United States,European countries and Japan,this paper evaluates the relative positions of DRG and DIP groups in China,and provides ideas for the reform of medical insurance payment in China.