针对国家医保局近年来开展的DRG支付改革试点,本文基于理论分析和8个试点地区的定性访谈,对DRG改革中的激励问题进行浅析。理论上讲,在“平均支付”标准下,医疗服务提供者有动机降低每位患者的治疗成本、增加住院人次、从每位患者身上获取更高的收入,但这些转变可能是基于推诿患者、分解住院等实现的,因此对提高医院服务效率和医疗质量是不确定的。定性研究显示,不同利益相关方在DRG改革中存在不同的激励反应,为防止激励结果偏离政策期望目标,本文提出相应政策建议。
Abstract
In view of the DRG payment reform pilots carried out by the National Healthcare Security Administration in recent years, this paper analyzes the incentive issues in the DRG reform based on theoretical analysis and qualitative interviews in eight pilot areas. In theory, under the standard of "average payment", medical service providers have the motivation to reduce the treatment cost of each patient, increase the number of inpatients, and obtain higher income from each patient. However, these changes may be based on the shift of patients, decomposition of hospitalization, etc., which is uncertain to improve hospital service efficiency and medical quality. Qualitative research shows that different stakeholders have different incentive reactions in the DRG reform. In order to prevent the incentive results from deviating from the policy expectations, this paper puts forward corresponding policy recommendations.
关键词
DRG改革 /
标尺竞赛 /
激励扭曲
Key words
DRG reform /
ruler competition /
incentive distortion
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参考文献
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基金
中国社会科学院青年人文社会科学研究中心青年社会调研项目“数字经济背景下就业模式转变与社会保障体系建设研究”（2022QNZX004）
