目的: 探讨我国DRG支付背景下各地基础病组名单的设定特点与规律,为优化基础病组政策提供科学参考。方法: 通过检索全国2022—2024年发布的政策文件,收集20个城市的基础病组名单及相关信息。采用描述性统计分析各地病组数量、疾病类别、权重范围,并计算Jaccard相似系数分析城市间相似性。结果: 各地基础病组数量差异显著（3~117个）。基础病组以内科诊断为主（85%）,权重值多集中于0.2~0.8,60%不伴并发症或合并症。主要诊断类别（MDC）最多分布在消化系统疾病及功能障碍（MDCG）。城市间相似性差异较大,雅安、保山等地相似度高,安阳、铜仁、银川等地因病组数量极端、细分组不同或地方特色相似度较低。结论: 建议优化基础病组遴选原则,兼顾地方疾病谱与医疗资源差异,动态监测其适配性;加强跨区域协作,强化数据支持,共同促进分级诊疗与医保支付效率优化。
Abstract
Objective: The paper explores the characteristics and rules of the list of basic disease groups in China under the background of DRG payment, in order to provide a scientific reference for optimizing the policy of basic disease groups. Methods: The list of basic disease groups and related information in 20 cities was collected by searching the policy documents released from 2022 to 2024 in China. Descriptive statistics were used to analyze the number of disease groups, disease categories and weight ranges in different regions, and the Jaccard similarity coefficient was calculated to analyze the similarity between cities. Results: There were significant differences in the number of basic disease groups, varying from 3 to 117. In the basic disease groups, 85% were mainly diagnosed by internal medicine, the weight values were mostly from 0.2 to 0.8, and 60% had no complications or comorbidities. The main diagnostic category (MDC) is most commonly distributed in digestive disorders and dysfunction (MDCG). There were large differences in similarity among cities, with Ya'an and Baoshan City having a high degree of similarity, while Anyang, Tongren, Yinchuan having a low degree of similarity due to the extreme number of disease groups, different sub-groups or local characteristics. Conclusion: It is recommended to optimize the selection principle of disease groups, take the differences in local disease spectrum and medical resources into account, and dynamically monitor their suitability. Also, cross regional collaboration data support should be strengthened, jointly promoting the optimization of hierarchical diagnosis and treatment and medical insurance payment efficiency.
关键词
DRG /
医保 /
基础病组 /
政策分析
Key words
DRG /
medical insurance /
basic disease group /
policy analysis
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参考文献
[1] 重庆市医疗保障局.《重庆市基本医疗保险按疾病诊断相关分组(DRG)付费办法(征求意见稿)》公开征求意见[EB/OL].(2024-03-14)[2025-01-07].https://ylbzj.cq.gov.cn/hdjl_535/yjzj/202403/t20240314_13038958.html.
[2] 银川市卫生健康委员会.关于印发《银川市医疗保险DRG基础病组标准分值》的通知[EB/OL].(2024-04-17)[2025-01-07].https://www.yinchuan.gov.cn/xxgk/bmxxgkml/ycsylbzj/xxgkml_38315/bmwj_38322/202304/t20230417_4033915.html.
[3] 浙江省医疗保障局.关于促进分级诊疗实行DRGs支付同病同价的通知[EB/OL].(2021-09-10)[2025-01-07].http://ybj.zj.gov.cn/art/2021/9/10/art_1229225623_2354996.html.
[4] 刘锋,曾伟航.DRG支付视角下分级诊疗现状及政策建议[J].环渤海经济瞭望,2024(2):139-142.
[5] 苏州市医疗保障局.关于印发《苏州市基本医疗保险按疾病诊断相关分组(DRG)付费管理办法(试行)》的通知[EB/OL].(2022-08-23)[2025-01-07].https://ybj.suzhou.gov.cn/szybj/jbyl/202208/f8fd68419d7b4973907efd1eebbc5df6.shtml.
[6] 湖北省医疗保障局办公室.关于印发《省本级按疾病诊断相关分组(DRG)付费医疗保障经办管理规程》的通知[EB/OL].(2024-12-10)[2025-01-07].https://ybj.hubei.gov.cn/zfxxgk/zc/gfwj/202412/t20241210_5444043.shtml.
[7] 李超凡,刘聪慧,孙铭阳,等.分级诊疗目标导向下DRG基础病组同病同价支付政策比较分析[J].协和医学杂志,2024,15(5):1045-1051.
[8] 林晓江,郑云蒸,洪东世,等.DRG支付改革促进分级诊疗的探索——基于温州市开展基础病组“同病同价”支付的实践[J].卫生经济研究, 2021,38(12):22-24.
[9] 孟凡舜,王海龙,靳伟,等.DRG付费下基础病组优化成效评估——以山东省某三级综合医院为例[J].中国医疗保险,2024(4): 85-90.
[10] 杨天悦,齐佳.哈尔滨深化DRG改革助力分级诊疗[J].中国医院院长,2024,20(17):70-71.
[11] ALI S U, IBRAIM Y, BELLO A.Assessing the suitability of the SLEUTH cellular automata model for capturing heterogeneous urban growth in developing cities: a case study in Northern Nigeria[J].Heliyon, 2024, 10(17): e36504.
[12] JIANG H, LUO S, QIN J, et al.Exploring the inter-monthly dynamic patterns of Chinese urban spatial interaction networks based on Baidu migration data[J].ISPRS International journal of geo-information, 2022, 11(9): 486.
[13] SHTAR G, ROKA L, SHAPIRA B.Detecting drug-drug interactions using artificial neural networks and classic graph similarity measures[J].PLOS ONE, 2019, 14(8): e0219796.
[14] 杨喜旺,冯文.DRG支付方式改革对医院病组结构的影响[J].广西医学, 46(6): 895-900.
[15] 李建苗,路杰,白焕莉.甘肃省基层医疗机构服务能力综合评价分析[J].卫生软科学,38(07): 46-51.
[16] 张振.天津市DRG医保支付方式改革实施效果评价研究[D].天津:天津工业大学,2023.
[17] 王锐,梁旭,马月丹.整合型医疗卫生服务体系功能定位、建设现状与经验[J].中国卫生经济,40(08):9-12.
[18] 刘建荣.Z市基层医疗卫生机构服务能力提升研究[D].长沙:湖南农业大学,2024.
[19] 张思佳.基层医疗机构糖尿病管理实施现状及促进与障碍因素研究[D].沈阳:中国医科大学.
[20] YANG J, LIU J, MA K, et al.Analysis of anatomic location of burns inpatients in China from 2009 to 2018[J].BMC public health, 2024, 24(1): 1799.
