CAJ | 학술논문

医疗服务支付方式改革是医药卫生体制改革核心问题之一.支付方式能够影响医疗服务利益相关者的行为,从而对医疗费用、医疗质量、医疗服务效率和医疗保险资金使用的效益产生影响.通过对利益相关者在按服务项目支付、按诊断相关组定额预付、总额预付3种支付方式中的行为分析发现,按诊断相关组定额预付既能够切实控制费用增长,使医疗质量得到保障,又能够较好地满足支付方式改革中各利益相关者的诉求.但是,各利益相关者在按诊断相关组定额预付支付中,需要不断完善病案首页数据填报、临床路径使用、信息系统建设、成本核算、费用结构调整等方面.
의료복무지부방식개혁시의약위생체제개혁핵심문제지일.지부방식능구영향의료복무이익상관자적행위,종이대의료비용、의료질량、의료복무효솔화의료보험자금사용적효익산생영향.통과대이익상관자재안복무항목지부、안진단상관조정액예부、총액예부3충지부방식중적행위분석발현,안진단상관조정액예부기능구절실공제비용증장,사의료질량득도보장,우능구교호지만족지부방식개혁중각이익상관자적소구.단시,각이익상관자재안진단상관조정액예부지부중,수요불단완선병안수혈수거전보、림상로경사용、신식계통건설、성본핵산、비용결구조정등방면.
The medical service payment system reform is one of core issues in medical and health system reform.The payment system can directly affect behavior of stakeholders and indirectly affect medical expense,quality of care,efficiency of medical services and efficiency of medical insurance funds.Through behavior analysis of stakeholders in fee for service,DRGs-PPS,global budget,DRGs-PPS is the best payment system that can control the irrational increase of medical expenses and ensure the level of health service and meets interest of stakeholders among three payment systems.In DRGs-PPS,stakeholders continuously make progress in filling in the front sheet of medical records,clinical pathway,construction of information system,cost calculation and restructure costs.