摘要
医保DRG支付改革是深化医疗制度改革的要求,已成为当前医保支付改革的趋势和潮流。“按病种分值付费”则是将统筹地区医保总额预算与点数法相结合,其实质是根据住院病案首页的主要诊断和手术编码对病例进行分组,参照统一的“病种分值库”确定病例的标准分值,累计分值越高,医保支付金额越多。然而在支付改革大背景下,基层医院的管理水平和医疗技术与上级医院存在差距,如何应对DRG支付改革是卫生院不得不面对的一个课题,该文就基层医院如何应对进行探讨,为卫生院的健康可持续发展提供可借鉴的经验。
The reform of medical insurance DRG payment is a requirement for deepening the reform of the medical system,and has become the current trend and trend of medical insurance payment reform."Pay by disease score"is a combination of the total budget of the overall medical insurance in the area and the point method.Its essence is to group the cases according to the main diagnosis and operation codes on the first page of the hospitalized medical record.Refer to the unified"disease type score database"to determine the standard scores of cases.The higher the cumulative score,the more medical insurance payments.However,in the context of payment reform,there is a gap between the management level and medical technology of primary hospitals and the superior hospitals.How to deal with the DRG payment reform is a topic that health centers have to face.The article discusses how to respond to primary hospitals,and provides lessons for the healthy and sustainable development of health centers.
作者
张建明
ZHANG Jianming(Medical Insurance and Medical Expenses Office of the Fourth Affiliated Hospital of Zhejiang University School of Medicine,Yiwu,Zhejiang Province,322000 China)
出处
《中国卫生产业》
2021年第25期104-107,共4页
China Health Industry
关键词
医保基金
医保支付
疾病诊断相关分组
病种分值付费
Medical insurance fund
Medical insurance payment
Disease diagnosis related grouping
Disease type score payment
