| 引用本文：邢怡青,谢涛,苗豫东,等.“强基层”导向下DRG/DIP支付与县域医疗服务体系价值的协同机制研究——基于新结构经济学的案例分析[J].中国卫生政策研究,2026,19(5):1-8 |
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| “强基层”导向下DRG/DIP支付与县域医疗服务体系价值的协同机制研究——基于新结构经济学的案例分析 |
| 投稿时间：2026-01-03 修订日期：2026-04-20 PDF全文浏览 HTML全文浏览 |
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邢怡青1，谢涛2，苗豫东1，张亮2，吴建1
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| 1郑州大学公共卫生学院 河南郑州 450001;2武汉大学政治与公共管理学院 湖北武汉 430072 |
| 摘要:目的 揭示DRG/DIP支付方式与县域医疗服务体系之间的协同关系及机制。方法 基于新结构经济学理论，构建“要素禀赋梳理-比较优势甄别-制约瓶颈识别-政策因势利导”分析框架，以重庆市Q区为案例进行系统剖析。结果 DRG/DIP支付改革初期对县域医疗服务体系价值产生抑制效应，主要体现为两条作用路径：一是总额预算管理层级上移，导致县乡之间的空间权力结构失衡；二是均值定价与机构等级系数形成的均质化定价机制，扭曲县乡机构间的空间竞合关系。两者叠加导致县级医院服务功能偏离定位、基层价值被低估，从而制约比较优势发挥与基层自生能力增强。结论 DRG/DIP支付改革与县域医疗服务体系协同推进，关键在于支付规则与县域内在的比较优势是否匹配；应发挥政府因势利导作用，通过优化预算管理单元、建立反映成本异质性的动态定价、以比较优势系数替代固化等级系数，将DRG/DIP支付由控费工具转为引导体系优化的战略杠杆。 |
| 关键词:县域医共体 DRG/DIP支付 新结构经济学 体系价值 |
| 基金项目:国家自然科学基金面上项目（72474162）；河南省软科学研究计划项目（262400411043） |
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| Synergy mechanisms between DRG/DIP payment and county-level healthcare system value under the strengthening primary care' orientation： A case analysis based on New Structural Economics |
| XING Yi-qing1, XIE Tao2, MIAO Yu-dong1, ZHANG Liang2, WU Jian1 |
| 1School of Public Health， Zhengzhou University， Zhengzhou Henan 450001， China;2School of Politics and Public Administration， Wuhan University， Wuhan Hubei 430072， China |
| Abstract:Objective This study aims to elucidate the synergistic relationship and underlying mechanisms between DRG/DIP payment systems and county-level healthcare systems.Methods Drawing on the theory of New Structural Economics， we developed an analytical framework consisting of four steps： “mapping resource endowments， identifying comparative advantage services‐recognizing constraint bottlenecks， policy guidance based on contextual conditions.” The framework was applied to a systematic case study of Q District in Chongqing.Results In the early stage of DRG/DIP payment reform， the value of the county-level healthcare service system was inhibited， primarily through two pathways： first， the upward shift of total budget management disrupted the spatial power structure between county and township levels； second， the homogenized pricing mechanism， comprising average-based pricing and institutional grade coefficients， distorted competitive and cooperative relationships among county- and township-level institutions. Together， these effects caused county-level hospitals to deviate from their intended service roles and led to the undervaluation of primary care services， thereby suppressing the realization of comparative advantage and the development of self-sustaining capacity at the grassroots level.Conclusions The successful synergy between DRG/DIP payment reforms and county-level healthcare service systems depends on aligning payment rules with the intrinsic comparative advantages of local institutions. Governmental intervention should be strategically applied to optimize budget management units， establish dynamic pricing that reflects cost heterogeneity， and replace fixed grade coefficients with comparative advantage coefficients. Such measures can transform DRG/DIP payments from mere cost-control tools into strategic levers for guiding systemic optimization. |
| Key words:County-level healthcare consortium DRG/DIP payment New Structural Economics System value |
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