Value conflicts and dynamic governance of doctor-patient relationships under the Diagnosis Related Groups payment system
10.12026/j.issn.1001-8565.2025.08.10
- VernacularTitle:DRG付费方式下医患关系的价值冲突与动态治理
- Author:
Jinwen REN
1
;
Jiaying ZHU
1
;
Jianjun JI
1
;
Xia LI
1
Author Information
1. 浙江省人民医院/杭州医学院附属人民医院医保物价办公室,浙江 杭州 310014
- Publication Type:Journal Article
- Keywords:
Diagnosis Related Groups payment;
doctor-patient relationship;
value conflict;
dynamic governance
- From:
Chinese Medical Ethics
2025;38(8):1022-1028
- CountryChina
- Language:Chinese
-
Abstract:
With the full implementation of the Diagnosis Related Groups(DRG)payment model,its institutional advantages in optimizing resource allocation and controlling medical costs through fixed disease payment standards have gradually emerged.However,it has also triggered structural value conflicts in the doctor-patient relationship.Based on the four principles of medical ethics,this paper constructed an analytical framework for the value conflicts in doctor-patient relationships under the DRG payment model.Starting from the manifestations of value conflicts,the inducements creating them were analyzed in depth.On these foundations,multi-dimensional optimization paths were proposed,including repairing respect-related conflicts through information transparency and decision-making co-governance;constructing a refined cost management system and embedding an ethical review mechanism to resolve non-harm conflicts;implementing a phased payment mechanism for innovative technologies and an ethical review exemption mechanism to alleviate benefit conflicts;as well as designing dynamic payment rules,unifying payment standards for insurance participation types,and strengthening dynamic monitoring to address justice conflicts.Under this framework,this paper aimed to promote the gradual transformation of DRG from a cost-control tool to a governance tool.While ensuring the security of the fund,it was necessary to maintain the bottom line of quality,stimulate technological innovation,and return to the patient-centered concept,thereby promoting the doctor-patient relationship to shift from a zero-sum game to a symbiotic and win-win situation.
