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  • 山东10市启动按疾病诊断相关分组付费试点

    将临床过程相似、医疗资源消耗相近的病人分入一组,以组为单位通过科学测算、协商确定出医保支付标准,医保机构按照每个组的 " 明码标价 " 给医院付费——这是目前被世界许多国家和地区广泛应用的一种医保付费模式,即按疾病诊断相关分组(英文 "Diagnosis Related Groups",简称 "DRG")付费。近日,省医保局在济南召开会议,全面启动按疾病诊断相关分组付费省级试点工作,我省医保支付方式迎来重大改革。

    医保支付方式改革,不仅是医疗服务管理的核心内容,也是整个医改的关键。目前我省推行的总额控制下多元复合医保支付方式,主要包括按项目付费、按人头付费、按病种付费、按总额预付方式付费等类型。

    " 此次启动 DRG 付费省级试点,标志着我省在深化医保支付方式改革进程中又向前迈出了坚实的一步。" 省医保局局长张宁波介绍说,首批选取省本级和济南、枣庄、东营、烟台、潍坊、威海、日照、临沂、聊城、菏泽 10 个市开展试点工作,我省成为全国省级试点城市最多的省份之一。

    什么是 DRG?它有什么优势?

    通俗来讲,DRG 付费就是根据患者的临床诊断、年龄、合并症、并发症等因素,把治疗疾病所产生的医疗费用相近的患者划分到相同的诊断组进行管理,将患者治疗疾病所产生的医疗费用以定额的形式提前支付给医院。如两个分别患有肺炎和支气管炎且不伴有其他合并症或伴随病的病例,均可归入同一个 DRG 组,也就是同一个费用标准。

    "DRG 付费是一种适用于短期危、急、重症住院医疗费用支付的方式,针对的是住院时间小于 60 天的住院病例。" 北京中日友好医院医务部副主任、国家 DRG 付费试点工作专家组成员焦建军告诉记者,门诊病例、康复病例、需要长期住院的病例不适用 DRG 付费。那些诊断相同、治疗方式相同,但资源消耗和(或)治疗结果变异巨大的病例,如精神类疾病,也不适合。

    对于适合的病例,用 DRG 打包付费,费用标准明确、范围清晰,患者治疗方法确定以后,医院、医生、患者、医保方都可以知道要支付多少。一个患者被诊断为急性阑尾炎需住院进行手术治疗,经过医生评估,他被分到的 DRG 组预估医疗费用为 5000 元。确诊后,医保部门将治疗费用 5000 元提前支付给医院。医院如果医疗质量好、医疗水平高,用少于 5000 元的医疗成本将患者治愈,则医院会产生费用结余。反之,如果医院因过度治疗等原因,花费更多的费用治愈患者,超出 5000 元的部分由医院自己承担。

    使用此模式,医院本身的盈利模式会发生巨大变化,从过去的以销售药品和耗材为主的盈利模式,变成了加强内部控制、降低成本、提高医疗质量才能获利的模式,能有效避免过度医疗,降低群众看病就医的费用,提高医保基金的使用效率。

    我省要求,试点地要按照顶层设计、模拟运行、实际付费三个阶段,计划用 2-3 年的时间,建立以保证质量、控制成本、规范诊断、提高医务人员积极性为核心的 DRG 付费和绩效管理体系,发挥医保支付的激励约束作用。并通过省级试点工作,制定符合我省实际的 DRG 支付标准、政策、规程,形成可借鉴、可复制、可推广的经验,为下一步以点带面全面推开 DRG 付费打下坚实基础。

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