基于DRGs支付方式的医疗服务体系优化策略研究——以浙江省公立医院为例

Research on the optimization strategy of medical service system based on DRGs payment method——Take public hospitals in Zhejiang Province as examples

关键词:  DRGs  医保支付方式  医疗服务体系  优化策略

Key words:  DRGs  Medical insurance payment method  Medical service system  Optimization strategy

摘要:

目的 结合DRGs制度在浙江省的推行现状和应用成效，为推进医保支付方式改革的同时不断优化医疗服务体系方面提出对策建议。方法 通过文献调研法与对比分析法，选取浙江省两家典型公立医院进行个案研究，比较分析医院在DRGs推行中所面临的问题并给出建议。结果 共回收有效问卷110份。经调研分析，两家医院仅在会计管理职能弱化问题上存在显著性差异（P<0.05）。工作岗位对于编码员应增强临床知识的掌握，备案管理相关专业毕业，具有编码合格证这三项呈现出0.01水平显著性，具有高度统计学意义。结论 我国可从加强病案首页数据管理，开发全省统一的DRGs综合付费数字平台，完善精细化的管理体系规划学科发展战略，完善病种分组来引导分级诊疗需求，配套激励制度以均衡国家财政补贴，加强三医联动提升医疗质量与效率等方面着手，推进医疗服务体系的全面发展。

Abstract:

OBJECTIVE Based on the current situation and application effectiveness of DRGs system in Zhejiang Province, this paper proposes countermeasures and suggestions for continuously optimizing the medical service system while promoting the reform of medical insurance payment methods. METHODS Through literature research and comparative analysis, two typical public hospitals in Zhejiang Province were selected for case studies to compare and analyze the problems faced by hospitals in implementing DRGs and provide suggestions.RESULTS A total of 110 valid questionnaires were collected. According to the investigation and analysis, the two hospitals have significant differences only in the weakening of accounting management function (p<0.05). For coders in the job position, they should enhance the mastery of clinical knowledge, graduate from relevant majors of filing management, and have coding certificate. These three items show a significant level of 0.01, which is highly statistically significant CONCLUSION China can start by strengthening the management of medical record homepage data, developing a unified DRGs comprehensive payment digital platform throughout the province, improving the refined management system, planning disciplinary development strategies, guiding graded diagnosis and treatment needs through disease grouping, supporting incentive systems to balance national financial subsidies, strengthening the linkage between the three medical institutions to improve medical quality and efficiency, and promoting the comprehensive development of the medical service system.