Impact of diagnosis-related group / diagnosis-intervention packet medical insurance payment method reform on hospitals and the improving strategies of hospitals_West China Medical Journal

Authors：

TAN Ling ¹ ,  TIAN Wei ² , LIU Xiaoyi ²

1. President’s Office, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan 610072, P. R. China;
2. Operation Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan 610072, P. R. China;

Corresponding author：

TIAN Wei, Email: tianwei128@163.com

Keywords：

Payment method of medical insurance; diagnosis-related group; diagnosis-intervention packet; influence; improving strategy

DOI：

10.7507/1002-0179.202205036

Video：

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Judging from the latest policies related to the medical insurance payment reform of the state and Sichuan province, the reform of medical insurance diagnosis-related group (DRG)/diagnosis-intervention packet (DIP) payment methods is imperative. The impact of DRG/DIP payment method reform on public hospitals is mainly analyzed from the aspects of hospital cost accounting and control, quality of filling in the first page of medical cases, coding accuracy, standard of medical practice, development of diagnosis and treatment technology innovation business, multi-departmental linkage mechanism, competition between hospitals, performance appraisal mechanism, and negotiation and communication mechanism. We should put forward hospital improvement strategies from the top-level design of the whole hospital and from the aspects of improving the quality of the first page of the cases and the quality of the coding, strengthening the cost accounting and control of the disease, carrying out in-hospital and out-of-hospital training, establishing a liaison model, finding gaps with benchmark hospitals, enhancing the core competitiveness of innovative technologies, and improving internal performance appraisal, etc., to promote the high-quality development of hospitals.

Citation： TAN Ling, TIAN Wei, LIU Xiaoyi. Impact of diagnosis-related group / diagnosis-intervention packet medical insurance payment method reform on hospitals and the improving strategies of hospitals. West China Medical Journal, 2022, 37(12): 1878-1881. doi: 10.7507/1002-0179.202205036 Copy

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2.	袁素维, 刘燕, 朱建征, 等. 我国医保支付方式改革的有效性边界研究. 中国卫生政策研究, 2018, 11(9): 24-27.
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4.	熊森林, 欧凡, 陈维雄, 等. 按病种分值付费下公立医疗机构的管理策略. 现代医院, 2022, 22(9): 1402-1405.
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9.	张昕男, 殷荣. DRG 对儿童类专科医院运行管理的影响研究. 卫生经济研究, 2021, 38(10): 40-42.
10.	麻卫军. 试论医疗保险费用支付方式改革对医院管理的影响. 商讯, 2021(30): 136-138.
11.	彭颖. 医保付费新模式对医院运营管理的影响及应对策略. 中国总会计师, 2019(7): 132-133.
12.	陈春晖. 医保支付方式改革的影响及医院应对策略. 时代金融, 2018(5): 284-285, 293.
13.	李琳. 基于 DRGs 支付方式下公立医院绩效方案研究. 商讯, 2021(28): 130-132.
14.	张延红. DRG 支付方式改革对医院的影响及政策建议. 财经界, 2021(29): 191-192.
15.	康蕾. 公立医院医保支付改革对有效产出的影响. 纳税, 2021, 15(28): 173-174.

1. 蔡滨, 周罗晶, 汤佳, 等. 浅析医保支付方式改革对公立医院运营管理影响及应对策略. 江苏卫生事业管理, 2022, 33(7): 911-914.
2. 袁素维, 刘燕, 朱建征, 等. 我国医保支付方式改革的有效性边界研究. 中国卫生政策研究, 2018, 11(9): 24-27.
3. 周雁. 医保支付方式改革对医院经济的影响与管理对策研究. 质量与市场, 2022(16): 169-171.
4. 熊森林, 欧凡, 陈维雄, 等. 按病种分值付费下公立医疗机构的管理策略. 现代医院, 2022, 22(9): 1402-1405.
5. 崔斌, 程斌, 朱兆芳, 等. DRG 付费模式下的医保基金监管指标体系构建. 中国卫生经济, 2022, 41(9): 29-32.
6. 国家医疗保障局. 国家医疗保障局关于印发 DRG/DIP 支付方式改革三年行动计划的通知: 医保发〔2021〕48 号. (2021-11-19)[2021-11-30]. http://www.gov.cn/zhengce/zhengceku/2021-11/28/content_5653858.htm.
7. 四川省人民政府办公厅. 四川省人民政府办公厅关于印发四川省推动公立医院高质量发展实施方案的通知: 川办发〔2021〕71 号. (2021-11-29)[2021-12-02]. https://www.sc.gov.cn/10462/zfwjts/2021/12/1/cbcaed802f864b989631a79638b45c01.shtml.
8. 健康界. 医保 DRG/DIP 改革对医院绩效管理的五大影响. (2021-09-30)[2022-12-08]. https://www.cn-healthcare.com/articlewm/20210930/content-1269515.html.
9. 张昕男, 殷荣. DRG 对儿童类专科医院运行管理的影响研究. 卫生经济研究, 2021, 38(10): 40-42.
10. 麻卫军. 试论医疗保险费用支付方式改革对医院管理的影响. 商讯, 2021(30): 136-138.
11. 彭颖. 医保付费新模式对医院运营管理的影响及应对策略. 中国总会计师, 2019(7): 132-133.
12. 陈春晖. 医保支付方式改革的影响及医院应对策略. 时代金融, 2018(5): 284-285, 293.
13. 李琳. 基于 DRGs 支付方式下公立医院绩效方案研究. 商讯, 2021(28): 130-132.
14. 张延红. DRG 支付方式改革对医院的影响及政策建议. 财经界, 2021(29): 191-192.
15. 康蕾. 公立医院医保支付改革对有效产出的影响. 纳税, 2021, 15(28): 173-174.

West China Medical Journal

Impact of diagnosis-related group / diagnosis-intervention packet medical insurance payment method reform on hospitals and the improving strategies of hospitals

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