DRG改革背景下医院卫生技术评估的功能与推行策略

医院卫生技术评估(HB-HTA)是专门针对医院实际情况进行评估的方法学工具,可辅助医院进行卫生技术管理与决策。HB-HTA与DRG均是医院管理的工具,二者价值理念相同、现实作用相近,可推动医院向精细化管理和高质量服务提供的发展方向迈进。在DRG改革中,HB-HTA可通过对卫生技术安全性、有效性和经济性评估,对同一病种的不同诊疗过程、技术和相应的配套措施进行分析和比较,帮助医院进行成本核算,优化"服务包"的安全有效性和成本效益,促进医院对DRG改革进行战略性回应。此外,HB-HTA还可覆盖到DRG短时间无法覆盖和不适宜以DRG支付的医疗服务,辅助医院对多元复合式医保支付方式进行整体性探索。未来,应在医院内部重点打造"HB-HTA+DRG"式医院精细化管理模式,同时要理顺组织体制、注重大数据开发和使用、加快HB-HTA试点工作并建立动态监管机制。

Research on the function and strategy of promoting hospital-based health technology assessment under the background of DRG reform

Hospital-based Health Technology Assessment(short as HB-HTA)is a methodological tool for assessing the actual situation of a hospital in order to assist in health technology management and decision-making in that specific hospital.Both HB-HTA and diagnosis related groups(DRGs)are important tools for hospital management.They have the same value concept and similar practical role,which can enhance the hospital to develop towards fine management and high-quality service provision.In the DRG reform,HB-HTA can be employed to analyze and compare different diagnosis and treatment processes,technologies and corresponding supporting measures of the same disease by assessing the safety,effectiveness and health technology economics.This helps hospitals carry out real and detailed cost accounting,optimized safety,effectiveness and cost-effectiveness of“service package”and promote the hospitals strategic responses to DRG reforms therein.In addition,HB-HTA can also cover some medical services that DRGs can t cover in a reduced period of time,and are not suitable for DRG payment,yet HB-HTA do assist hospitals in the exploration of multiple composite medical insurance payments as a whole.It is suggested that,in the future,a“HB-HTA+DRG”hospital refined management model should be established within the hospital and at the same time the organizational system should be rationalized;attention should be paid to the development and big data should be used in the healthcare system clustering;HB-HTA pilot work should be speeded up and a dynamic regulatory mechanism should be established.