引用本文: 程斌,朱兆芳,崔斌,等.DRG付费模式下医保基金监管机制探讨[J].中国卫生经济,2022,41(9):33-36.[点击复制] Cheng Bin,Zhu Zhaofang,Cui Bin,et al.Discussion on the Supervision Mechanism for the Healthcare Insurance Fund under DRG Payment[J].CHINESE HEALTH ECONOMICS,2022,41(9):33-36.[点击复制]
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DRG付费模式下医保基金监管机制探讨
程斌,朱兆芳,崔斌,史纪元,孙谦,杨琳,王淞
0
(国家卫生健康委卫生发展研究中心 北 京 100044;北京大学医学部 北 京 100191;烟台市医疗保障局 烟 台 264003;安徽医科大学 合 肥 230032;潍坊医学院 山东 潍 坊 261053;英国谢菲尔德大学 谢菲尔德 S102TN)
摘要:
探索我国按疾病诊断相关分组付费模式下医保基金监管机制,有助于促进诊疗行为规范,提高基金使用效率, 确保基金安全和参保人的权益。文章通过文献研究,分析并借鉴国内外医保基金监管机制。建议完善医保基金监管体系,加强多方协同联动机制;构建以结果为导向、以过程监管为核心的监管指标体系,建立智能监管系统;日常监管与定期评价相结合,建立按疾病诊断相关分组付费下基金监管绩效考核机制。
关键词:  按疾病诊断相关分组  医保支付方式改革  医保基金监管机制
DOI:
基金项目:
Discussion on the Supervision Mechanism for the Healthcare Insurance Fund under DRG Payment
Cheng Bin,Zhu Zhaofang,Cui Bin,Shi Jiyuan,Sun Qian,Yang Lin,Wang Song
(China National Health Development Research Center, Beijing, 100044 , China)
Abstract:
Exploring the supervision mechanism of medical insurance funds under the DRG payment model in China will help to promote the diagnosis standardization, improve the efficiency of fund use, and ensure the safety of funds and the rights and interests of insured persons. It analyzes and draws lessons from the domestic and foreign medical insurance fund supervision mechanism through literature research. It is recommended to improve supervision system of the healthcare security fund, strengthen the multi-party coordination and linkage mechanism, establish a result-oriented supervision index system with process supervision as a core, build an intelligent regulatory system, combine daily supervision with regular evaluation, and establish a performance assessment mechanism under DRG payment.
Key words:  Diagnosis Related Group  the reform of medical insurance payment system  the supervision mechanism for the medical insurance

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