目的: 通过分析山东改革成效和治理经验,为其他省市推进异地就医支付方式改革提供参考借鉴。方法: 基于国家医疗保障局CHS-DRG1.1修订版分组器,使用描述性统计方法分析改革前后的基金支付、医疗费用和病种结构等情况。结果: 山东异地住院费用支付方式改革取得积极成效,同一地区本地和异地同质化效果显现,但改革深层次问题未完全解决,面临着病种结构不够合理、跨区域“同病不同价”问题。结论: 亟须加快推进分级诊疗,加强成本核算,完善预算结算清算措施,直至破解异地就医不平衡不充分问题。

This paper summarizes the effectiveness and governance experience of Shandong Province, and provides reference for other provinces and cities to promote the payment method reform for remote medical treatment. Methods: Based on the revised grouper CHS-DRG 1.1 Version of the National Health Security Administration, this paper uses descriptive statistical methods to analyze the fund payment, medical expenses and disease structure before and after the reform. Results: The reform of the payment method of non-local hospitalization expenses in Shandong Province has achieved positive results, and the homogenization effect of local and non-local patients in the same area has appeared, but the profound problems of the reform have not been completely solved, such as unreasonable disease structure and different prices for the same disease in cross-regional treatment. Conclusion: It is urgent to accelerate the promotion of hierarchical diagnosis and treatment, strengthen cost accounting, and improve budget settlement and liquidation measures, in order to solve the problem of unbalanced and insufficient medical treatment in different places.