Enlightenment of the DRG payment reform in the United States on the reform of China′s medical insurance payment methods
10.3760/cma.j.cn111325-20220920-00818
- VernacularTitle:美国DRG付费改革历程对我国医保支付方式改革的启示
- Author:
Yipei WANG
1
;
Yanbing ZENG
;
Kaihua GAO
;
Wei FU
;
Changxiao JIN
Author Information
1. 北京大学第三医院医院管理研究室，北京 100191
- Keywords:
Medical security;
Medical insurance;
Payment reform;
Diagnosis-related groups;
Case-mix specialization;
Cost;
United States
- From:
Chinese Journal of Hospital Administration
2023;39(2):93-96
- CountryChina
- Language:Chinese
-
Abstract:
In order to curb the excessive growth of medical expenses, the United States has initiated payment reform of diagnosis-related groups (DRG) since 1983, and developed a series of complementary measures to address issues such as overcoding and declining healthcare service quality which were exposed during the reform. The authors discussed the implementation of DRG payment reform in the United States, namely the case-mix specialization of medical institutions and the reduction of costs, as well as the relationship between the two. On this basis, the authors suggested that when implementing reforms to the medical insurance payment system in China, it is imperative to avoid such loopholes as overcoding by medical institutions and excessive pursuit of efficiency at the expense of quality control, as well as the decline of comprehensive rescue capability and quality of care incurred by the exacerbated specialization.
