目的: 探索DRG不同病组支付特点,进行分类管理的结算管理方案。方法: 对DRG分组原理与结算管理办法进一步研究分析,将病组类别划分为目标总控、重点监管和重点激励病组等分类,结合DRG运行期间部分效能指标的横向与纵向比对,形成分类管理方案。结果: 目标总控病组通过总量控制方式实现对相关病组住院人次不合理增长的控制;重点激励病组,从临床技术发展与医保结算管理的角度进行支持,提高了医疗机构收治患者与提升技术实力的积极性。

Objective: The paper explores the payment characteristics of different disease groups under DRG payment and carries out the settlement management scheme of classified management. Methods: The DRG grouping principle and settlement management method was further studied and analyzed, and the disease groups were divided into total amount control disease groups, key supervision disease groups and key incentive disease groups, etc. The classification management scheme was formed by combining the horizontal and vertical comparison of some efficiency indicators during the DRG operation. Results: The total amount control disease groups achieved the control of irrational increase in the number of inpatients in the relevant disease groups by means of total amount control. The key incentive disease groups were supported from the perspective of clinical technology development and medical insurance settlement management, ensuring the initiative of medical institutions to treat patients and improve technology.