CAJ | 학술논문

为解决基本医疗保险运行过程中出现的次均费用持续大幅增长、医保基金面临超支等问题，国内在许多城市如北京等多地开展总额预付试点改革工作，取得了一定的成效。澳大利亚则采用病例组合资金模型（DRGS），被世界上许多国家和地区所借鉴。总额预付制和DRGS两种机制各有利弊，通过对这两种机制的利弊分析与对比研究，期望为国内医疗保险制度改革有所借鉴、应用和启发。
위해결기본의료보험운행과정중출현적차균비용지속대폭증장、의보기금면림초지등문제，국내재허다성시여북경등다지개전총액예부시점개혁공작，취득료일정적성효。오대리아칙채용병례조합자금모형（DRGS），피세계상허다국가화지구소차감。총액예부제화DRGS량충궤제각유리폐，통과대저량충궤제적리폐분석여대비연구，기망위국내의료보험제도개혁유소차감、응용화계발。
To solve the ever-increasing average cost of medical care, the over-expenditure of the medical insurance fund and so on, the Chinese government has carried out the total pre-service payment in many cities in China, such as Beijing. However, Australia chooses the diagnosis related groups mode which is called DRGS for short. It’s referred by many countries in the world. Because there are pros and cons for the two modes, I will make the comparison and demonstration for medical fund government compensation policy of China and diagnosis related groups mode . The investigation will be helpful for our country to get the analysis, reference, application and enlightenment from the current policy reform.