日本诊断群分类支付制度改革经验及启示
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摘要
按病种付费是我国支付制度改革的重点。借鉴日本诊断群分类支付制度改革经验,提出完善我国按病种付费制度的政策路径:厘清病种支付制度改革逻辑,适度整合DRG和病种(组)分值支付优点,有效衔接医师费和医院费、供方和需方两对关系,将弹性支付机制作为调节阀,完善医保信息系统智能化建设。
Paying by disease is the focus of China's payment system reform. Drawing on the experience of the Japanese diagnostic group classification payment system reform,this paper proposed a policy path to improve the disease-based payment system in China:clarifying the logic of the reform of the disease payment system,moderately integrating the advantages of DRG and disease group,and effectively linking physician fees and hospitals. The relationship between fee,supplier and demander will be used as a regulating valve to improve the intelligent construction of medical insurance information system.
Paying by disease is the focus of China's payment system reform. Drawing on the experience of the Japanese diagnostic group classification payment system reform,this paper proposed a policy path to improve the disease-based payment system in China:clarifying the logic of the reform of the disease payment system,moderately integrating the advantages of DRG and disease group,and effectively linking physician fees and hospitals. The relationship between fee,supplier and demander will be used as a regulating valve to improve the intelligent construction of medical insurance information system.
引文
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[3] Ishii M.DRG/PPS and DPC/PDPS as Prospective Payment Systems[J].JMAJ,2012,55(4):279-291.
[4] Etsuji O, Toshiro K.Estimation of per-case hospitalization charges from Diagnosis-Procedure-Combination data and an international comparison of hospital prices[J].Journal of the National Institute of Public Health,2014,63(6):532-537.
[5]谭华伟,张培林,姚旭,等.公立医院医疗项目作业成本核算方法实践研究[J].卫生经济研究,2018(10):41-46.
[6]颜维华,谭华伟,张培林,等.我国公立医院内部绩效管理的RBRVS实践[J].卫生经济研究,2018(12):47-51,54.
[7]贾洪波,段文琦.基本医保按病种分值付费的实践探索[J].卫生经济研究,2018(5):57-59.
[8]仇雨临.医保与三医联动:纽带、杠杆和调控阀[J].探索,2017(5):65-71.
[2] Yoshiaki N,Tadamasa T,Hiroyuki Y,et al.A New Accounting System for Financial Balance Based on Personnel Cost After the Introduction of a DPC/DRG System[J].Journal of medical systems,2011(35):251-264.
[3] Ishii M.DRG/PPS and DPC/PDPS as Prospective Payment Systems[J].JMAJ,2012,55(4):279-291.
[4] Etsuji O, Toshiro K.Estimation of per-case hospitalization charges from Diagnosis-Procedure-Combination data and an international comparison of hospital prices[J].Journal of the National Institute of Public Health,2014,63(6):532-537.
[5]谭华伟,张培林,姚旭,等.公立医院医疗项目作业成本核算方法实践研究[J].卫生经济研究,2018(10):41-46.
[6]颜维华,谭华伟,张培林,等.我国公立医院内部绩效管理的RBRVS实践[J].卫生经济研究,2018(12):47-51,54.
[7]贾洪波,段文琦.基本医保按病种分值付费的实践探索[J].卫生经济研究,2018(5):57-59.
[8]仇雨临.医保与三医联动:纽带、杠杆和调控阀[J].探索,2017(5):65-71.