DRG支付制度中低码高编行为实证分析研究

程文炜; 常维夫

doi:10.19546/j.issn.1674-3830.2022.9.002

中国医疗保险 ›› 2022, Vol. 0 ›› Issue (9) : 11-15. DOI: 10.19546/j.issn.1674-3830.2022.9.002

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DRG支付制度中低码高编行为实证分析研究

程文炜, 常维夫

作者信息 +

Empirical Analysis of Upcoding Behavior in DRG Payment

Author information +

文章历史 +

摘要

以我国某DRG付费制度改革试点城市为研究样本,实证分析DRG支付制度实施前后相同ADRG组下各DRG组的病例数及构成比变化情况,选择DRG支付制度实施后病例数出现较大增长且伴有严重合并症或并发症的DRG组进行中断时间序列分析。结果显示试点城市医院存在低码高编行为。低码高编是DRG支付制度改革中的重点管控方向,可以通过加强病案首页质控以及诊断编码的培训学习等方式防范和降低低码高编道德风险,保障DRG支付制度良性运转。

Abstract

Taking a DRG payment system reform pilot city in China as a research sample, we empirically analyzed the changes in the number of cases, the composition ratio of each DRG group under the same ADRG group before, after the implementation of DRG. Interrupted time series analysis was performed in the DRG group with severe comorbidities or complications. The results showed that there were upcoding behaviors in hospitals of the pilot city, which must be regulated. We can strengthen the training, learning of medical record, diagnostic coding, ensure the healthy operation of DRG

导出引用

程文炜, 常维夫. DRG支付制度中低码高编行为实证分析研究[J]. 中国医疗保险. 2022, 0(9): 11-15 https://doi.org/10.19546/j.issn.1674-3830.2022.9.002

Empirical Analysis of Upcoding Behavior in DRG Payment[J]. China Health Insurance. 2022, 0(9): 11-15 https://doi.org/10.19546/j.issn.1674-3830.2022.9.002

中图分类号： F840.684C913.7

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