国外DRGs定价与支付体系对我国医保支付方式改革启示

卫生总费用的高速增长对国内医保支付体系造成了巨大压力。正在开展的医保支付方式改革将由按项目付费向按病种付费转变。本文分析了国内医保支付方式改革的方向和预期目标,从适宜的管理体系、医疗服务定价有效性、医疗服务补偿合理性等方面剖析了改革面临的难点和瓶颈,从主要支付体系模型及其作用、成本核算方法以及基于未来成本的考量3方面分析了国外DRGs定价与支付体系,总结了国内医保支付方式改革可借鉴的经验。

The reference significance of foreign DRGs implementation strategy to the reform of medical insurance payment in China

The rapid growth of China's total health expenditure has put tremendous pressure on the medical insurance payment system.The ongoing reform of medical insurance payment methods will shift from pay-by-item to pay-by-case.This article analyzes the direction and expected goals of the reform of China's medical insurance payment methods,analyzes the difficulties and bottlenecks faced by the reform in terms of appropriate management systems,the effectiveness of medical service pricing,and the reasonableness of medical service compensation.This paper analyzes the implementation strategies of DRGs in major European and American countries based on 3 aspects of cost accounting methods and consideration of future costs,and summarizes the experience that can be drawn from the reform of medical insurance payment methods in China.