新医改政策下公立医院实施DRGs-PPS的难点分析.pdfVIP

中国卫生信息管理杂志2013年10月第10卷第5期 Chinese Journal of Health Informatics and Management, Oct.2013, Vol.10, No.5 中国卫生信息管理 CHINESE JOURNAL OF HEALTH INFORMATICS AND MANAGEMENT doi:10.3969/j.issn. 1672-5166.2013.05.016 新医改政策下公立医院实施 DRGs-PPS的难点分析 ① ① ① ①△ 邱  杰   董旭南   斯  琴   温  浩 文章编号：1672-5166（2013)05-0452-04    中图分类号：R-34；R197    文献标志码：A 摘  要 疾病诊断相关分组-预付费制（DRGs-PPS ）是一种社会医疗保障部门管理和监督医疗机构支付方 式的重要工具，也是国内外医疗机构对医务人员行为和医疗质量控制常用的方式之一。该方法对新医改方 案的成功起到了一定的促进作用。本文结合新疆样本医院DRGs分型中数据提取与数据分析的实际案例，对 DRGs-PPS基础数据在医院信息系统提取过程中的干扰因素以及临床路径与DRGs-PPS之间的关联性等问题 进行了深入的分析。同时，对区域医保政策性文件与医院实际情况不对称性的基本原因进行探讨，为地方性 区域医保部门和医院评估决算提供决策依据。 关键词 社会医疗保障 医院管理 疾病诊断相关分组预付费制（DRGs-PPS ） Issues to Be Addressed in the Implementation of DRGs-PPS in Public Hospitals under the New Health Care System Reform Policy Qiu Jie, Dong Xunan, Si Qin, Wen Hao The First Affiliated Hospital of Xinjiang Medical University, Urmuqi 830011, Xinjiang China Abstract DRGs-PPS is an important tool in social medical insurance management and supervision of medical organizations payment. It is also a common approach for medical staff supervision and medical quality control. DRGs-PPS can promote the implementation of new health care reform policies. Based on the real-world case in a sample hospital in Xinjiang Uyghur Autonomous Region, this article analyzes the DRGs typing and data extraction, the interference factors of DRGs-PPS, and the relevance between the electronic clinical pathway and DRGs-PPS. Also, the authors discusses the reasons of the unmatched health policies and the actual situation of the hospitals, with an attempt to provide evidence for better decision-making. Key words Social