通讯作者: 张璐莹, zhangluying@fudan.edu.cn

DOI：10.12201/bmr.202410.00024

Progress and Reflections on Innovative Medical Technologies Payment Mechanism under DRG/DIP Payment in China

• 摘要：目的：梳理我国各地DRG/DIP付费下创新医疗技术支付机制实践进展,并提出政策完善建议。方法：收集截至2024年4月各省市DRG/DIP付费改革的政策文件进行内容分析,并对部分试点城市医疗保障部门相关负责人进行深入访谈。结果：共有45个国家DRG/DIP支付方式改革试点城市和19个省级扩面城市的改革文件中包含了创新医疗技术支付机制。其中,DRG付费城市的创新医疗技术支付机制包括纳入已有分组或新增分组、专家论证评议、调整分组权重/机构系数、单独支付、鼓励向新医疗技术倾斜、清算时补差等8类做法,DIP付费城市划分为专家评议后确定加成分值、采用不同计算规则确定分值等6类做法。上海、杭州、南京的做法较有特色,分别为在支持产业发展中向新技术倾斜、设置退坡激励和多维调节机制下精准补偿。结论：需要在国家或省级层面统一界定创新医疗技术的范围,完善准入和退出机制；利用退坡激励机制促进创新技术由短期向长期支付的过渡；在DRG/DIP付费之外要坚持总额控制,完善对新技术合理使用的监管。

  关键词： DRG/DIP付费; 创新医疗技术; 支付机制; 政策分析

   

  Abstract: Objective：To collate the progress of innovative medical technology payment mechanism under DRG/DIP payment in different parts of China, and raise suggestions for policy improvement. Methods：The study analysed policy documents on DRG/DIP payment reform in provinces and municipalities up to April 2024 and conducted in-depth interviews with relevant heads of healthcare security departments in some pilot cities. Results：A total of 45 national DRG/DIP payment reform pilot cities and 19 provincial expansion cities included innovative technology payment mechanisms in the reform documents. The innovative technology payment mechanism for DRG-paying cities includes eight types of practices such as incorporating existing subgroups or adding new subgroups, expert argumentation and deliberation, adjusting subgroup weights/institutional coefficients, separate payment, encouraging tilting towards new medical technologies, and making up the difference in liquidation, etc. The DIP-paying cities are classified into six types of practices such as determining the additive scores after expert deliberation, and determining the scores by adopting different computation rules. The practices of Shanghai, Hangzhou and Nanjing are more typical, namely tilting towards new technologies in supporting industrial development, setting up regressive incentives and precise compensation under a multi-dimensional adjustment mechanism. Conclusion：It is necessary to give a harmonised definition of innovative technologies at the national or provincial level and to complete its access and exit mechanism; using the rebate incentive mechanism helps promote the transition from short-term to long-term payments; adherence to the total amount of control in addition to DRG/DIP payment and improvement of the regulation are important.

  Key words: DRG/DIP payment; innovative medical technologies; payment mechanism; policy analysis

  提交时间：2024-10-11

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
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• 序号	提交日期	编号	操作
  1	2024-05-24	bmr.202410.00024V1	下载

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