目的:本研究以浙江省DRG创新技术除外支付政策为研究对象，分析该政策的设计逻辑、遴选路径与成效，为全国医保支付方式改革支持医药创新提供经验参考。方法:采用文献研究、政策实践分析相结合的方法，首先对DRG除外支付政策进行理论剖析，其次聚焦浙江省创新医药技术医保支付激励目录管理制度及首批激励目录，剖析申报、审评、支付三大核心机制，最后总结目录遴选特征与制度实施效果，识别政策运行中的关键挑战。结果:浙江省构建了以医疗机构为申报主体，以多维度指标审评和3年退坡式点数追加补偿为核心的支付激励机制，形成含25个药品、3个医疗服务项目、2个医用耗材的首批激励目录。结论:浙江省DRG除外支付实践为促进创新医药技术在DRG支付中的临床应用提供了可参考的方案。同时，面对政策优化与执行监管方面的挑战，研究提出建立动态评估机制、强化数智监管等建议，以进一步提升政策可持续性与精准性。
Abstract
Objective:This study examines Zhejiang Province's DRG exclusion payment policy for innovative technologies, analyzing its design logic, selection pathways, and outcomes, with the aim of providing insights for nationwide healthcare payment reforms to support medical innovation. Methods:Combining literature review and policy practice analysis, the study first provides a theoretical analysis of the DRG exclusion payment policy. It then focuses on Zhejiang Province's incentive catalog management system for innovative medical technologies under medical insurance payment and its first incentive catalog, exploring the three core mechanisms of application, evaluation, and payment. Finally, it summarizes the characteristics of catalog selection and the implementation effects of the system, identifying key challenges in policy operation. Results:Zhejiang Province has established a payment incentive mechanism centered on healthcare institutions as the applicants, multi-dimensional evaluation indicators, and a three-year degressive point-based supplementary compensation system. The first incentive catalog includes 25 drugs, 3 medical service items, and 2 medical consumables. Conclusion:Zhejiang Province’s DRG exclusion payment practice offers a referential model for promoting the clinical application of innovative medical technologies under the DRG payment. Meanwhile, addressing challenges in policy optimization and implementation supervision, the study proposes recommendations such as establishing a dynamic evaluation mechanism and enhancing digital-intelligent supervision to further improve policy sustainability and precision.
关键词
医药创新 /
DRG /
除外支付 /
浙江
Key words
pharmaceutical innovation /
DRG /
exclusion payment /
Zhejiang Province
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