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我国医疗服务收付费方式改革进入DRG时代

2017-09-22 07:38:07   中国经济网

“今年是国家启动DRG收付费改革试点的第一年,今天国家卫生计生委卫生发展研究中心主办(以下简称“卫生发展研究中心”)的这个大会,提供了一个相互交流、分享经验、共同推进、达成共识的平台。希望此次大会召开,让我们进一步增强紧迫感和责任感,凝聚力量,凝聚智慧,攻坚克难,力求在收付费改革试点上不断进步,逐步形成可复制、可推广的收费改革的路径和模式。”9月14日,国家卫生计生委马晓伟副主任在“中国DRG收付费大会”上表示,DRG收付费方式“是一个很好的收付费制度”,既是解决取消以药补医,推进建立新的补偿机制综合改革的措施,也是提高医保基金使用率的有效方法,可以让广大患者享受到改革的成果,更加合理地配置医疗资源,提高医疗服务的质量,控制医疗费用的不合理增长。

正如国家卫计委财务司副司长樊挚敏所说,收付费方式是决定医改能否成功、效果能否持续的重要标识。据主办方介绍,来自国内外相关领域的政策制定者、管理人员、临床医务人员、研究学者、企事业单位人员2200余人出席了本次会议,人数远超主办方预期。由此不难看出,推进DRG收付费改革,发挥控成本、降费用、保质量、提效益的作用已成为广大医务工作者的共识。

什么是“全国按疾病诊断相关分组”收付费

DRG(Diagnosis Related Groups)收付费,又称按疾病诊断相关分组收付费,是将病人按照疾病严重程度、治疗方法的复杂程度以及资源消耗的不同分成若干组,以组为单位分别定价打包支付的一种付费方式,也是目前国际上最为广泛使用的住院医疗服务的支付方式,是世界上公认的最有效的控制医疗费用的一种方法。

据卫生发展研究中心名誉主任、《全国按疾病诊断相关分组收付费规范》课题组组长张振忠教授介绍,DRG收付费规范是在借鉴国际经验和我国部分省市推行DRG经验和教训的基础上,紧密结合我们国家的具体国情和医疗保障体系,以及公立医院补偿机制的实际情况所创建的一套供全国应用的公益性的收付费体系。

张振忠从技术和规则上详细解释了什么是“全国按疾病诊断相关分组”收付费。“这里面有三个关键词,‘按疾病诊断’‘相关’‘分组’。‘疾病诊断’就是我们得了病以后医生给诊断疾病是什么,这和疾病的严重程度相关;‘相关’和治疗该疾病所使用的方法密切相关;‘分组’与治疗该疾病过程中的资源消耗相关。有了这三个最主要的因素,对所有的疾病可以进行分组。课题组组织专家团队把几万条可以作为诊断的疾病按照临床相似性原则先归入23个系统,然后再按治疗方式归成三大类,建立了《临床疾病诊断规范术语集》,这是首次把疾病诊断的名称统一起来用于C-DRG的分组”。

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