Investigation on the current status of health insurance CHS-DRG/DIP performance evaluation of hospitals in China
10.3760/cma.j.cn111325-20240618-00496
- VernacularTitle:我国医院医保CHS-DRG/DIP绩效考核现状调查
- Author:
Yutong WANG
1
;
Xiaokun LIU
;
Xueqin SUN
;
Wei ZHANG
;
Wenting ZHENG
;
Chen XIE
;
Rui DONG
;
Weiguo ZHU
;
Ding HAN
Author Information
1. 中国医学科学院北京协和医院医疗保险管理处，北京 100730
- Publication Type:Journal Article
- Keywords:
Diagnosis related groups;
Diagnosis-intervention packet;
Performance evaluation;
Medical insurance;
Questionnaires
- From:
Chinese Journal of Hospital Administration
2025;41(1):55-62
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the current status of implementing medical insurance performance evaluation in the hospitals of China under the background of China Healthcare Security Diagnosis Related Groups (CHS-DRG) and Diagnosis-Intervention Packet (DIP) payment reform, explore the perspectives and recommendations of key department leaders (e.g., health insurance, medical affairs, pricing, and performance evaluation departments) regarding health insurance performance evaluation, analyze the influencing factors in its implementation, so as to provide references for hospitals to develop and refine health insurance performance evaluation strategies.Methods:A questionnaire was designed and distributed to hospitals across 31 provincial-level administrative regions in China from December 1 to 31, 2023. The survey targeted secondary and tertiary general or specialized hospitals. The main responsible persons from four functional departments, including medical insurance, healthcare, pricing, and performance, were invited to participate in the survey. Descriptive analysis was conducted on the questionnaire data, and the chi-square test was used for differential analysis of unordered categorical variables, while the Wilcoxon rank sum test was used for differential analysis of ordered categorical variables.Results:A total of 761 valid questionnaires were collected. Most respondents were health insurance department leaders (420, 55.19%). Among them, 741 respondents reported that their hospitals used CHS-DRG or DIP payment, with 258 indicating that their hospitals had already developed and implemented health insurance performance evaluation plans. A majority (685, 90.01%) expressed support for such initiatives. Influencing factor analysis revealed that hospital type, level, scope of health insurance management departments, and payment methods might impact the implementation of health insurance performance evaluation ( P<0.05). Conclusions:Few hospitals have currently adopted health insurance performance evaluation, underscoring the urgency to establish a scientific and reasonable evaluation plan as a robust tool for internal hospital management.
