摘要
在医保支付方式深化改革的大背景下,疾病诊断相关分组(diagnosis related groups,DRG)作为医保改革的关键政策,在其推进落实的过程中如何体现出控费和提质的双重导向,公立医院如何解读与应对,已成为新时期医疗卫生领域的“必答题”。文章将多源流理论与标尺竞争理论有机结合,构建理论分析框架,定性推导出DRG控费提质双重导向在理论上的合理性和必要性,同时得到现阶段尚存在矛盾点的结论。通过医保、医管双视角,对DRG改革中控费和提质矛盾点产生的原因进行分析与细化,再提出对策建议,为进一步完善与落实DRG政策提供支持。
Under the background of deepening medical insurance payment method reform,diagnosis related groups(DRG)are the key policy of medical insurance reform.In promoting its implementation,how to reflect the dual orientation of cost control and quality improvement and interpret and respond to it in public hospitals have become the“required question”in the new medical field.This paper organically combines the Multiple⁃Streams theory with the Yardstick competition theory to build a theoretical analysis framework,which qualitatively deduces the theoretical rationality and necessity of the dual orientation of cost control and quality improvement of DRG while concluding that there are still contradictions at the present stage.Through the detailed correspondence of DRG reform from the perspectives of medical insurance and medical management,this paper analyzes and refines the causes of contradictions and then proposes corresponding countermeasures to support further improvement and implementation of DRG policy.
作者
王浩宇
周典
周苑
田帝
吴烨
WANG Haoyu;ZHOU Dian;ZHOU Yuan;TIAN Di;WU Ye(School of Health Management,Anhui Medical University,Hefei 230032;Office of Party Committee,the Second Affiliated Hospital of Anhui Medical University,Hefei 230601;Department of Medical Administration,the Second Affiliated Hospital of Anhui Medical University,Hefei 230601;Department of Medical Administration,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Department of Human Resources,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)
出处
《南京医科大学学报（社会科学版）》
2023年第3期212-216,252,共6页
Journal of Nanjing Medical University（Social Sciences）
基金
国家卫建委医院管理研究所项目“循证管理视角下医院DRG水平与医疗控费提质作用机制研究”(YL⁃ZLXZ22K001)
之江实验室横向课题“面向新一代信息技术的多模态医疗大数据智能管理软件”(ZJGZSQ)
安徽省高等学校科学研究重大项目“公立医院高质量发展背景下基于H⁃TOE模型的合理用药发展策略研究”(2022AH040158)
安徽省教育厅高校协同创新项目“医联网环境下的全生命周期医疗健康大数据治理研究”(GXXT-2022-058)
安徽医科大学医院管理研究所项目“医院高质量发展视角下临床路径与DRG协调发展策略研究”(2022gykj06)。
关键词
疾病诊断相关组
医保改革
政策分析
多源流理论
标尺竞争理论
diagnosis related groups
reform of medical insurance
policy analysis
Multiple⁃Streams theory
Yardstick competition theory
