| 引用本文：高红霞, 李云萧, 张研, 陈迎春, 刘洋基, 王辉珠, 司华.医保DRGs与公立医院管理的价值协同机制探析[J].中国卫生政策研究,2019,12(11):23-28 |
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| 医保DRGs与公立医院管理的价值协同机制探析 |
| 投稿时间：2019-07-18 修订日期：2019-10-24 PDF全文浏览 HTML全文浏览 |
| 高红霞1,2, 李云萧1,2, 张研1,2, 陈迎春1,2, 刘洋基3, 王辉珠3, 司华3 |
1. 华中科技大学同济医学院医药卫生管理学院 湖北武汉 430030;
2. 湖北省人文社科重点研究基地农村健康服务研究中心 湖北武汉 430030;
3. 甘肃省会宁县人民医院 甘肃白银 730700 |
| 摘要:目的：通过整理和分析H医院DRGs付费方式改革与成效，尝试构建DRGs与医院管理的协同理论模型。方法：通过对H医院的管理文件进行梳理，理清DRGs与医院内部管理改革的逻辑关系；调取医院2017年9月-2018年12月的运行数据，选择发生占比前五位疾病为目标病种，通过医疗费用等指标评估改革成效。结果：临床路径人次覆盖率由45.32%上升到了60.74%，病案首页填报完整率由95.31%提升至99.01%，住院人次增长16.28%，医务人员人均绩效工资涨幅23.19%；排除医疗服务价格调整的影响，代表性疾病次均费用波动性下降，降幅为100~300元。结论：通过医保DRGs与医院协同管理系统环，H医院以效率提升、质量维持和成本降低验证了DRGs能够协同医院管理实现价值共创。 |
| 关键词:按疾病诊断相关分组付费 医院管理 绩效管理 价值协同 |
| 基金项目:中央高校基本科研业务费专项基金（HUST2018KFYYXJJ064）；中央高校基本科研业务费专项基金（HUST2016YXZD030）；华中科技大学文科双一流建设项目基金 |
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| Analysis of the value synergetic mechanism between DRGs of health insurance and public hospitals management |
| GAO Hong-xia1,2, LI Yun-xiao1,2, ZHANG Yan1,2, CHEN Ying-chun1,2, LIU Yang-ji3, WANG Hui-zhu3, SI Hua3 |
1. School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei 430030, China;
2. Rural Health Service Research Center, Hubei Provincial Humanities and Social Sciences Key Research Base, Wuhan Hubei 430030, China;
3. Huining People's Hospital, Baiyin Gansu 730700, China |
| Abstract:Objective:Through reorganizing the reform measures and analyzing the effectiveness of the DRGs payment methods in H hospital, this paper considers assessing whether the DRGs reform brings value to medical insurance and hospitals, and constructs a synergistic theoretical model of DRGs and hospital management. Methods:Through the management documents of H hospital, the logical relationship between DRGs and hospital internal management reform was clarified. Meanwhile, the 2017.9-2018.12 period's hospital operational data were retrieved, and the top five diseases were selected as the target diseases to evaluate the effectiveness of the reforms through indicators such as medical expenses. Results:The coverage rate of clinical pathways increased from 45.30% to 60.08%. The complete rate of report on the front page of the medical record increased from 95.31% to 99%, the number of hospitalized patients increased by 16.28%, and the per capita performance salary of medical staff increased by 23.19%. The effect of price adjustment on medical services was excluded. The average cost of major diseases received a decrease of 100~300 yuan. Conclusions:Through the combination of medical insurance DRGs and hospital collaborative management system loop, H hospital has verified that DRGs can achieve the value creation in collaboration with hospital management with efficiency improvement, quality maintenance and cost reduction, respectively. |
| Key words:DRGs Hospital management Performance management Value synergy |
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