北京市按病组付费初期试点情况和效应分析.pdfVIP

〉〉医家之言 北京市按病组付费 初期试点情况和效应分析 简伟研 1 卢 铭 1 胡 牧 2 （1北京大学医学部 北京 100191；2北京大学第三医院医保办 北京 100191） 【摘要】目的 ：对北京市2012 年实施按病组付费试点的执行情况和效应进行初步评估。方法 ：对照北 京市全部医保定点三级医院的情况，分析试点医院两周再入院率、病例组合指数、例均个人支付额、例均 住院时间 2008 年至 2012 年的变化，评估按病组付费对医疗服务的影响。结果 ：6家试点医院的按病组付费 结算率的平均值为 64.81%。试点医院按病组结算的病例个人负担下降、住院时间缩短、两周再入院率下降、 病例组合指数值上升。 【关键词】诊断相关组，支付，试点，北京 【中图分类号】F840.684 C913.7【 文献标识码】 A 【 文章编号】1674-3830（2015）3-52-4 doi:10.369/j.issn.1674-3830.2015.3.12 The Situation and Effectiveness Analysis of the Pilot Implement of Diagnosis Related Groups Payment in Beijing　1Jian Weiyan,1Lu Ming,2Hu Mu（1Peking University Health Science Center, Beijing, 100191,2Peking University Third Hospital Health Insurance Of? ce, Beijing, 100191） 【Abstract】This paper aimed to evaluate the practice situation and the effect after the pilot implement of diagnosis related groups (DRGs) payment in Beijing. Comparing to the the tertiary hospitals in Beijing, we analyze the changes of two-week re-admission rate, Case-mix Index, out-of-pocket payment per case and hospitalization stay per case in the pilot hospitals after DRGs payment was initiated during the year of 2008-2012, and estimate its in? uence on medical services. As a result, the average settlement rate of DRG payment in the six pilot hospitals is 64.81% and the out-of-pocket payment by patients, hospitalization stay and two-week re-admission rate are all decreased, while the case-mix index of the pilot hospitals is increased. 【Key words】diagnosis related groups (DRGs), payment, pilot, Beijing