CAJ | 학술논문

自2011年10月，北京市在全国率先实施按病种组合定额支付结算（DRGs-PPS）。本研究采集了2008年至2012年北京市职工医保病人出院病历数据，以6家试点医院为研究组，选择了8家与试点医院规模相当的医院作为对照。从便利性、患者可负担性、供方可负担性、保方可负担性、医疗质量、服务能力和服务效率等七个方面，对DRG-PPS的效果进行了初步分析。分析结果显示，试点方案可行、流程运行平稳，取得了医院收入不减、患者负担减轻、基金增长可控的初步成效。试点说明在北京实施DRGs-PPS是可行的。
자2011년10월，북경시재전국솔선실시안병충조합정액지부결산（DRGs-PPS）。본연구채집료2008년지2012년북경시직공의보병인출원병력수거，이6가시점의원위연구조，선택료8가여시점의원규모상당적의원작위대조。종편리성、환자가부담성、공방가부담성、보방가부담성、의료질량、복무능력화복무효솔등칠개방면，대DRG-PPS적효과진행료초보분석。분석결과현시，시점방안가행、류정운행평은，취득료의원수입불감、환자부담감경、기금증장가공적초보성효。시점설명재북경실시DRGs-PPS시가행적。
In October , 2011, Diagnosis Related Groups- Prospective Payment System? DRGs-PPS?were initiated in Beijing. This paper used descriptive statistics method to compare the data of 108 groups of cases during the year of 2008 to 2012 in 6 pilot hospitals and 8 control hospitals, thus to evaluate the effectiveness of the pilot scheme. The main indices included case difficulty coefficient (CMI), the statistics of item cost, settlement fees, insurance payment, personal burden, the average hospitalization days, two weeks re-hospitalization rate etc. It is concluded that the pilot scheme is feasible, the process was smoothly operated. After the initiation, it demonstrated that the hospital income did not reduce, while the patients’ burden was reduced, and the growth of fund was controllable, therefore the implementation of the DRGs-PPS in Beijing is feasible.