DRGs付费对天津市医保制度改革的启示

目的总结按病种编码付费方式在全国的应用情况,及其对天津市医疗保险制度改革的启示。方法以全国医疗保险制度从统筹支付过渡到DRGs按病种支付改革为例,通过查阅相关文献,全面梳理DRGs付费制度支付方式在天津市医疗保险制度改革中的前景和预期成效,同时对天津市医疗保险机构推进DRGs付费制度改革提出针对性建议,借鉴国内外DRGs付费制度改革的相关经验,推动天津市DRGs按病种付费改革试点工作的健康开展。结果DRGs付费制度可以有效规范医疗卫生机构行为,节省医疗保险基金,减轻患者的经济负担,降低患者的住院总费用。同时,该制度可以帮助医疗保险资金监督机构监控医院行为。结论DRGs付费制度可以有效帮助医疗保险监督机构规范医院诊疗行为,在今后的医疗保险制度改革中应大力推广应用。

The enlightenment of DRGs payment to the reform of Tianjin medical insurance system

Objective To summarize the application of payment by disease code in the whole country,and its enlightenment to the reform of Tianjin medical insurance system.Methods Taking the transition of national medical insurance system from overall payment to DRGs payment by disease reform as an example,this paper comprehensively combed the prospect and expected effect of DRGs payment system in Tianjin medical insurance system reform by consulting relevant literature,and put forward targeted suggestions for Tianjin medical insurance institutions to promote DRGs payment system reform.Also,by drawing experiences from domestic and foreign DRGs payment system reform,the healthy development of DRGs payment by disease pilot work could be promoted in Tianjin.Results The DRGs payment system could effectively regulate the behavior of medical and health institutions,save the medical insurance fund,reduce the economic burden of patients,and reduce the total hospitalization cost of patients.At the same time,the system could help the medical insurance fund watchdog monitor hospital behavior.Conclusion The DRGs payment system could effectively help the medical insurance supervision institutions to regulate the hospital diagnosis and treatment behavior,which should be vigorously promoted in the future medical insurance system reform.