摘要
DIP付费作为一种适应我国国情的原创支付方式,依托客观真实临床病案大数据形成“疾病诊断+治疗方式”的组合,能够精准反映临床资源消耗并根据真实资源消耗予以支付。但不管是DRG还是DIP支付方式,均未在支付决策中充分考量各类临床干预价值的差异。本研究基于DIP特性并考虑不同病种组合的临床转归优劣及相对性价比,遵循国内外权威的价值评估理念,运用多准则决策分析、层次分析法等系统研究方法,以急性阑尾炎、阵发性房颤、结直肠癌、肺癌、乳腺癌五个试点疾病及其对应的病种组合入手,探索建立适用于DIP病种组合的综合价值评估方法学。对同一疾病诊断下不同的治疗操作DIP组进行综合价值评估,然后依据价值评估结果提出医保基于价值的支付调整建议,即高价值多支付,低价值少支付。在医保基金区域总额预算的前提下提高医保基金使用效率并促进临床转归,为医保以价值为基础的战略性购买提供科学有效的依据和参考。
As an original payment method that suits China's national conditions,DIP payment forms combination of disease diagnoses and interventions based on real-world clinical record,which can precisely reflect the clinical resource consumption and make payments based on actual resource consumption.However,neither DRG nor DIP payment methods have adequately considered the differences of value in clinical intervention in payment decisions.Based on globally acceptable value assessment concepts and methods such as multi-criteria decision analysis and analytic hierarchy process,this study conducted analysis on five pilot diseases of acute appendicitis,atrial fibrillation,colorectal cancer,lung cancer and breast cancer,to explore and establish a comprehensive value assessment framework uniquely suitable for DIP grouping methodology.Based on the value assessment results of various DIP groups’interventions under the same diagnosis,a value-based payment adjustment system were proposed for policy makers to reimburse more on high value DIP groups and less on comparatively low value groups.The efficiency of healthcare security fund utilization was improved and the clinical outcomes was promoted under the premise of regional total budget,providing scientific and effective reference for value-based strategic purchase of healthcare security.
出处
《中国医疗保险》
2023年第12期21-30,共10页
China Health Insurance
基金
广州市医疗保障局委托研究课题“基于大数据的病种组合临床综合价值评估研究”(HT-99982021-0589)。
