| 引用本文：方金鸣, 刘玲, 彭义香, 陶红兵.DRG改革中医保机构的诉求对其行为的影响研究[J].中国卫生政策研究,2021,14(10):38-44 |
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| DRG改革中医保机构的诉求对其行为的影响研究 |
| 投稿时间：2021-09-02 修订日期：2021-10-12 PDF全文浏览 HTML全文浏览 |
| 方金鸣1,2, 刘玲3, 彭义香3, 陶红兵2 |
1. 武汉市第四医院 华中科技大学同济医学院附属普爱医院 湖北武汉 430033;
2. 华中科技大学同济医学院医药卫生管理学院 湖北武汉 430030;
3. 华中科技大学同济医学院附属武汉中心医院 湖北武汉 430014 |
| 摘要:目的：对DRG改革中医保机构的诉求和行为进行调查，并分析其诉求对行为的影响。方法：通过问卷调查，对医保机构在DRG下的诉求和行为进行因子分析，分别提取了诉求和行为的公因子，通过线性回归，分析了诉求对行为的影响。结果：DRG改革下，医保机构的诉求包括促进医疗机构服务能力提升、医保机构经办能力提升、医保机构的医疗评估能力提升、医保机构的监管能力提升四个方面。医保机构的行为集中于调整DRG政策、开展监督考核、与医方协商三个方面。医保机构的诉求侧重点决定了医保机构行为的重点方向。结论：DRG改革下，医保机构的诉求和行为跟既往有所不同。通过了解医保机构重点诉求来判断其行为的重点方向，对于把握当地改革方向有着很好的预测作用。 |
| 关键词:DRG 医保机构 利益诉求 行为 因子分析 |
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| Research on the impact of demands of medical insurance facilities on their behaviors in the context of DRG reform |
| FANG Jin-ming1,2, LIU Ling3, PENG Yi-xiang3, TAO Hong-bing2 |
1. Wuhan Fourth Hospital, Pu'ai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei 430033, China;
2. School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei 430030, China;
3. The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei 430014, China |
| Abstract:Objective: To investigate the demands and behaviors of medical insurance facilities in the context of DRG reform, and analyze the impact of their demands on their behaviors. Methods: Via questionnaire survey, the demands and behaviors of medical insurance facilities in DRG were analyzed by factor analysis, and the common factors of demands and behaviors were extracted respectively. Then the impact of demands on behaviors was analyzed by linear regression. Results: In the context of DRG reform, the demands of medical insurance facilities included four aspects: promoting the service capacity of medical facilities, improving the case handling ability of medical insurance facilities, improving the medical care evaluation ability of medical insurance facilities, and improving the supervisory ability of medical insurance facilities. The behaviors of medical insurance facilities were mainly in three aspects: adjusting DRG policy, executing supervision and assessment, and negotiating with medical facilities. The focused aspect of medical insurance facilities' demands determined the key direction of their behaviors. Conclusions: In the context of DRG reform, the demands and behaviors of medical insurance facilities were somewhat different from those of the past. Judging the key direction of their behaviors by understanding their demands should provide reliable predictive information to help control the direction of local reform. |
| Key words:DRG Medical insurance facilities Interest demands Behaviors Factor analysis |
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