DRGs在沈阳市医保支付管理中的应用--以医疗服务绩效评价为主

摘要

Objective Shenyang, as one of the pilot cities of the project Application of DRGs (diagnosis related groups) in the Management of Health Insurance Payment proposed by the journal of "China Health Insurance", would summarize the implementation measures, operation route, and expanding experiences of using DRGs in health insurance management. Method Under the instruction of the expert team, and considering the general situation of local area, we set the goal of using DRGs, took the way of promoting grouping management and standardizing medical report simultaneously, paying after management, made core team playing roles, and brought DRGs and index test into medical insurance performance evaluation and medical service supervision. Results In only one year, we have established DRGs data quality control expert team, used DRGs in evaluating the performance of medical care, and laid foundations for insurance payment by DRGs.%目的：意义：沈阳市作为由《中国医疗保险》杂志社牵头的“DRGs在医保支付管理中的应用”课题试点城市，总结DRGs在医保管理中的实施方法、操作路线和推广经验。实施方法：在课题专家组指导下，结合本地实际确定DRGs应用目标，采取分组管理与病案规范同步推进、先管理再付费的方法，发挥核心团队作用，将DRGs分组和指标评定用于医保考核评定管理和医疗服务监控。结果：仅仅一年的时间，建立起DRGs数据质量控制专家队伍，将DRGs应用于医疗保险购买的医疗服务绩效评价，为实施按病种分组（DRGs）付费奠定了基础。