DRG与DIP的改革实践及发展内涵

疾病诊断相关组(DRG)与基于大数据的病种分值付费(DIP),其设计思维和方案框架都来源于国际社会的疾病诊断相关组(DRG),区别在于DRG采取的是收敛的、取不同病种共性的最大公约数的分组原则,而DIP则采取更加具体细化的分组思路,其结果是国家医保局颁布的DRG有618个病组、DIP则有14052个病组。广州的DIP试点中,存在相当部分的人为、管理因素,导致支付不稳定和预测困难;沈阳的DRG试点方案相对稳定、客观、操作方便,对医疗机构行为和医疗资源配置产生了较好的效果。DIP只是完成全面DRG付费的一个过渡手段,随着地方实践的成熟,必将会形成更具科学性、系统性和长期性的医保支付体系。

Reform Practice and Development Connotation of DRG and DIP

The way of thinking and frameworks of both disease diagnosis related group(DRG)and the DIP based on big data are derived from the DRG of the international community.The difference is that DRG adopts the principle of convergence and taking the greatest common divisor of the commonality of different diseases,while DIP adopts specific and detailed ideas.As a result,the DRG issued by the National Health Security Administration is divided into 618 disease groups and DIP is 14052 groups.Guangzhou as the DIP pilot area,there are a considerable number of human and management factors in the accounting formula,which leads to instability and forecasting difficulties.Shenyang as the DRG pilot,the plan is relatively stable,objective and easy to operate.The behavior of medical institutions and the allocation of medical resources have produced good results.DIP is just a transitional means in the process of completing a full DRG payment.