DRG/DIP付费下异化行为表现及监管建议

廖藏宜; 张艺艺

doi:10.19546/j.issn.1674-3830.2023.2.004

中国医疗保险 ›› 2023, Vol. 0 ›› Issue (2) : 27-34. DOI: 10.19546/j.issn.1674-3830.2023.2.004

专题分析

DRG/DIP付费下异化行为表现及监管建议

廖藏宜, 张艺艺

作者信息 +

Manifestations of Alienation Behaviour Under DRG/DIP Payment and Regulatory Recommendations

Author information +

文章历史 +

摘要

DRG/DIP付费会产生政策改革的“引致效应”,医疗机构基于利益动机容易出现应对新型支付方式的异化行为,导致医保基金监管面临严峻挑战。本文从数据质控端、医疗行为端和医院管理端三个维度,厘清了DRG/DIP付费下的异化行为内涵及其外延表现,提出了进一步加强医保基金精准监管和靶向监管的政策建议。

Abstract

DRG/DIP payment will have a "induced effect" of reform, because medical institutions will respond to the new payment method based on profit motive and trigger alienation behaviour, which could result in a serious regulatory situation for the medical insurance fund. This paper clarifies the connotation of DRG/DIP payment alienation behavior and their external manifestations from three dimensions of data quality control, medical behavior and hospital management, and accordingly proposes policy recommendations on how to conduct precise and targeted regulation.

导出引用

廖藏宜, 张艺艺. DRG/DIP付费下异化行为表现及监管建议[J]. 中国医疗保险. 2023, 0(2): 27-34 https://doi.org/10.19546/j.issn.1674-3830.2023.2.004

Manifestations of Alienation Behaviour Under DRG/DIP Payment and Regulatory Recommendations[J]. China Health Insurance. 2023, 0(2): 27-34 https://doi.org/10.19546/j.issn.1674-3830.2023.2.004

中图分类号： F840.684 C913.7

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