摘要
本研究以国际经验与本土实践为双支点,系统梳理美国、德国、澳大利亚等国家的DRG绩效评价做法,以及我国3个地区按病组（DRG）/病种分值（DIP）付费的绩效评价实践探索,经过多轮医保部门、医疗机构、专家学者的研讨和论证,选取2个地区进行试评价,最终构建出一套DRG/DIP绩效评价体系（以下简称绩效评价体系）。该绩效评价体系采用定量与定性相结合的方法,从改革覆盖、实施质量、诊疗服务、患者受益4个维度切入,设置15个指标,能较为全面、科学地评估支付方式改革的进展和成效。该研究不仅为医保部门评估改革成效、调整改革政策提供了重要参考,还可为医疗机构优化内部管理、提升服务质量提供决策依据,对推动我国支付方式改革高质量发展具有重要的理论价值和现实意义。
Abstract
This study takes international experience and local practice as the two supporting points, systematically sorting out the DRG performance evaluation practice of countries such as the United States, Germany, and Australia, as well as the practice of Diagnosis Related Groups (DRG) / Diagnosis-Intervention Packet (DIP) performance evaluation in three regions of China. Through multiple rounds of discussions and demonstrations participated by healthcare security authorities, medical institutions, experts and scholars, two regions were finally selected for trial evaluation, and a performance evaluation system for payment by DRG/DIP (hereinafter referred to as the performance evaluation system) was ultimately constructed. This performance evaluation system adopts a method combining quantitative and qualitative analysis. Starting from four dimensions, namely reform coverage, implementation quality, diagnosis and treatment services, and patient benefits, 15 indicators are set up, which can comprehensively and scientifically evaluate the progress and effectiveness of the payment method reform. This study not only provides an important reference for healthcare security authorities to evaluate the effectiveness of the reform and adjust reform policies, but also provides a decision-making basis for medical institutions to optimize internal management and improve service quality. It has important theoretical value and practical significance for promoting the high-quality development of payment method reform in China.
关键词
DRG /
DIP /
绩效评价体系
Key words
DRG /
DIP /
performance evaluation system
郝丽盼, 屈海龙, 应亚珍.
按病组/病种分值付费绩效评价体系构建研究[J]. 中国医疗保险. 2025, 0(6): 5-12 https://doi.org/10.19546/j.issn.1674-3830.2025.6.001
Research on the Construction of Performance Evaluation System for DRG/DIP Payment[J]. China Health Insurance. 2025, 0(6): 5-12 https://doi.org/10.19546/j.issn.1674-3830.2025.6.001
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 张琪,张书尹.英、澳、美三国卫生系统绩效评价比较分析及启示[J].中国循证医学杂志,2016,16(09):993-1000.
[2] The Agency for Healthcare Research and Quality.2023 National Healthcare Quality and Disparities Report[EB/OL].(2023-12-01)[2025-05-15].https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2023-nhqdr-rev.pdf.
[3] The Agency for Healthcare Research and Quality. Quality Indicator Empirical Methods, 2023[EB/OL].(2023-09-01)[2025-05-15].https://qualityindicators.ahrq.gov/Downloads/Resources/Publications/2023/Empirical_Methods_2023.pdf.
[4] SERDEN L, LINDQVIST R, ROSEN M.Have DRG-based prospective payment systems influenced the number of secondary diagnoses in health care administrative data?[J]. Health policy,2003,65(2):101-107.
[5] 邵晓军,蒋伊石,王思晨.DRG标杆管理在德国的应用[J].中国医院院长,2023,19(23):72-75.
[6] The Expert Group on Health Systems Performance Assessment. Mapping metrics of health promotion and disease prevention for health system performance assessmen[EB/OL].(2023-06-06)[2025-05-15].https://health.ec.europa.eu/document/download/5705734e-5779-4dca-bdd3-d80f917f32fe_en?filename=hspa_mapping-metrics_health-promotion_disease-prevention_report_en.pdf.
[7] K ACHSTETTER, M BLUMEL, P HENGEL, et al.Piloting a health system performance assessment for Germany-insights from trend and equity analyses[J]. European journal of public health,2022,10(32):535.
[8] 赵苗苗,吴群红,滕百军,等.国外医院绩效评价的比较分析与对我国的启示[J].中国卫生经济,2011,30(08):70-72.
[9] 蒋锋. 绩效考核这件事——其他国家做了什么[J].中国卫生,2021(04):32-33.
[10] 应亚珍.以改革的高质量推动发展的高质量[EB/OL].(2024-02-01)[2025-05-15].https://mp.weixin.qq.com/s/-dsqqAJre6AE9_XMDAzn7Q.
[11] 应亚珍,曹庄.如何认识DIP改革的后发优势[J].中国卫生,2020(12):47-48.
