摘要
在进一步深化医疗保险支付方式改革的进程中,对DRG分组和付费方式提出了更高的技术要求。住院病例经过DRG分组并实现结算的过程中,出现了包括高/低倍率病例、医疗资源消耗客观情况下高于组内其他病例的特殊病例。如何合理解决这些特殊病例,是进一步实现医保精细化管理、推进DRG付费改革进程的重要环节,本文以四川省眉山市DRG付费的实践为例,探索更优化的解决路径。
In the process of further deepening the reform of medical insurance payment mode,higher technical requirements are put forward for DRG grouping and payment mode.In the process of DRG grouping and settlement of inpatient cases,there are special cases including high/low rate cases and higher consumption of medical resources than other cases in the group.How to reasonably solve these special cases is an important link to further realize the refi ned management of medical insurance and promote the reform process of DRG payment.This paper takes the practice of DRG payment in Meishan of Sichuan Province as an example to explore a more optimized solution path.
作者
郭建国
许斯略
余佳莹
周小林
吴婧文
余丽君
Guo Jianguo;XuSilve;Yu Jiaying;Zhou Xiaolin;Wu Jingwen;Yu Lijun(Meishan Healthcare Security Bureau,Meishan,620020;Shanghai Kingstar Winning Software Science and Technology CO.,LTD.,Shanghai,200040)
出处
《中国医疗保险》
2021年第2期55-59,共5页
China Health Insurance
关键词
DRG
特殊病例
特病单议
高倍率病例
DRG
special cases
separately discussed on special cases
high rate cases
