目的: 探讨DRG/DIP体系下新医药技术的医保支付机制。方法: 基于文献综述和理论研究,梳理总结国内外打包支付下新医药技术支付方式的经验,对我国DRG/DIP体系下医保支付政策设计进行分析。结果: 国际上实施DRG支付的国家和地区在新医药技术初期多采用除外支付或设置新分组和费率的方法予以支付,积累充分信息后再将其纳入DRG一般支付体系。我国各地试点经验中的思路与国际经验基本一致,但具体制度流程尚比较模糊,有待进一步完善。结论: 我国DRG/DIP体系下新医药技术的医保支付,应在评估筹资能力的基础上,借鉴典型国家和地区的经验,综合考虑短期和长期支付方法,从而对新医药技术给予合理支付。
Abstract
Objective: The paper attempts to explore the mechanism of medical insurance payment for new medical technology under DRG/DIP system. Methods: Based on literature review and theoretical research, the experience of new medical technology payment methods under package payment at home and abroad was summarized, and the design of medical insurance payment policy under DRG/DIP system was analyzed. Results: The countries and regions that implement DRG payment usually pay the new medical technology by exclusion payment or set new groups and rates at the initial stage of the new medical technology, and then incorporate it into the DRG general payment system after accumulating sufficient information. The idea of pilot experience in China is basically consistent with international experience, but the specific system and process is still fuzzy and needs to be improved. Conclusion: On the basis of evaluating the financing ability, we should learn from the experience of typical countries and regions and consider the short-term and long-term payment mechanism, so as to make a reasonable payment for the new medical technology under the DRG/DIP payment system.
关键词
疾病诊断相关分组 /
按病种分值付费 /
新医药技术
Key words
DRG /
DIP /
innovative medical technology
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参考文献
[1] 李乐乐,李怡璇.我国医保支付方式改革的治理路径分析——基于DRG与DIP的机制比较[J].卫生经济研究,2022,39(09):43-48.
[2] FINOCCHIARO C M, GUCCIO C, PIGNATARO G, et al.The effects of reimbursement mechanisms on medical technology diffusion in the hospital sector in the Italian NHS[J]. Health Policy, 2014, 115(2-3): 215-229.
[3] SCHELLER-KREINSEN D, QUENTIN W, BUSSE R.DRG-based hospital payment systems and technological innovation in 12 European countries[J]. Value Health, 2011, 14(8): 1166-1172.
[4] 国家医疗保障局.关于印发疾病诊断相关分组(DRG)付费国家试点技术规范和分组方案的通知[EB/OL].(2019-10-24)[2022-06-22].http://www.nhsa.gov.cn/art/2019/10/24/art_37_1878. html.
[5] 彭颖,金春林,王贺男.美国DRG付费制度改革经验及启示[J].中国卫生经济,2018,37(07):93-96.
[6] CMS. Application for New Medical Services and Technologies Seeking to Quality for AddOn Payments Under the Hospital Inpatient Prospective Payment System for Federal Fiscal Year2023[EB/OL].[2022-12-02].https://www.cms.gov/Medicare/Medicare-Fee-forService-Payment/AcuteInpatientPPS/newtech.
[7] 吴晶,董心月,赵博雅.美国DRG下高值创新医疗技术的支付政策及启示[J].中国医疗保险,2022(06):118-124.
[8] 郎婧婧,于丽华.典型国家DRG体系下新技术支付政策分析及启示[J].中国卫生质量管理,2022,29(04):21-24.
[9] CMS HHS. Medicare Program; Change in Methodology for Determining Payment for Extraordinarily High-Cost Cases (Cost Outlier) Under the Acute Care Hospital Inpatient and Long Term Care Hospital Prospective Payment Systems[EB/OL].(2003-6-9)[2022-12-02].https://www.federalregister.gov/documents/2003/06/09/03-14492/medicareprogram-change-in-methodology-fordetermining-payment-for-extraordinarilyhigh-cost-case.
[10] BUSSE R, GEISSLER A, QUENTIN W, et al.Diagnose-Related Groups in Europe: Moving Towards Transparency, efficiency and quality in hospitals[M]. Germany: Open University Press and WHO Regional Office for Europe, 2011: 131-147.
[11] 蒋伊石,邵晓军.德国G-DRG医院偿付系统实施回顾与借鉴[J].中国卫生经济,2020,39(02):93-96.
[12] 李伟,任雨青,丁锦希,等.德国DRG医院偿付系统中创新产品支付模式分析[J].中国医院,2021,25(12):40-42.
[13] EX P, VOGT V, BUSSE R, et al.The reimbursement of new medical technologies in German inpatient care: What factors explain which hospitals receive innovation payments[J].Health Econ Policy Law, 2020,15(3):355-369.
[14] 林倩,王冬.中国台湾DRGs支付制度介绍及借鉴[J].中国卫生事业管理,2017,34(09):643-645.
[15] 石朗敏,冯国忠.台湾地区全民健保支付方式改革研究及启示[J].卫生软科学,2020,34(11):81-84.
[16] 徐嘉婕,王美凤,王海银,等.中国台湾地区创新医疗技术支付进展及经验[J].中国卫生资源,2020,23(01):59-62.
