Analysis of payment policies for special cases under the DRG payment mode of different regions in China
10.3760/cma.j.cn111325-20240524-00428
- VernacularTitle:DRG付费模式下我国各地特殊病例支付政策的分析
- Author:
Qiang MAO
1
;
Kun YANG
;
Peng LEI
Author Information
1. 荆楚理工学院附属荆门市中心医院运营中心，荆门 448000
- Publication Type:Journal Article
- Keywords:
Diagnosis related groups;
Payment standards;
Policy text;
Unstable group;
High-rate cases;
Low-rate cases
- From:
Chinese Journal of Hospital Administration
2025;41(3):203-209
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the payment policies for local special cases in China under the DRG payment mode, for references for improving the construction of China′s DRG payment system.Methods:Policy texts related to DRG settlement management measures and implementation rules were searched on the official websites of the people′s governments, medical security bureaus, and health commissions of prefecture level cities, county-level cities, and DRG payment pilot cities in China. The policy release time range was from May 2019 to March 2024. Content analysis method was used to summarize the judgment criteria and payment methods for determining unstable groups, high-rate and low-rate cases in various regions.Results:This study included a total of 74 policy texts covering 76 cities. 59 cities had established judgment criteria for unstable groups, using the number of enrolled cases and the threshold for the coefficient of variation of hospitalization expenses within the group as the basis for determination; 46 cities had established relevant payment methods, 40 cities of which adopted fee-for-service, or individual payment for special diseases (whole group). 72 cities had established judgment criteria and payment methods for high-rate cases. Among them, 68 cities used " hospitalization expenses for cases are higher than the prescribed multiple of the average cost or payment standard for this disease group" as the judgment criterion, and the majority of cities (40) adopt additional benchmark points for compensation payment. 70 cities had clarified the judgment criteria and payment methods for low-rate cases. Among them, 67 cities used " hospitalization expenses for cases that are less than the prescribed multiple of the payment standard or average cost per case" as the criteria, and pay based on point conversion or fee-for-service.Conclusions:There were certain differences in the judgment criteria and payment methods for special cases among different cities, which provided valuable references for the in-depth exploration of DRG payment reform in China. We should further strengthen the innovation of special case screening methods, attach importance to disease cost accounting, and improve the construction of special case payment systems.
