Objective To analyze the causes of high-rate DRG cases and to propose effective management countermeasures to address the challenges posed by high-rate cases to the economy of hospitals and the quality of medical services.Methods Data of 6 937 high-rate cases and 120 782 normal-rate cases were analyzed using Excel 2021,and the causes of high-rate cases were analyzed in conjunction with the results of medical quality inspections.Results High-rate cases exhibit significantly higher average benchmark points and per capital hospitalization costs compared to normal cases,especially those with benchmark points exceeding 300,where the average cost reaches up to 151 906.70 yuan.The high-rate cases were concentrated in the group of complex diseases such as invasive ventilator support ≥96 hours or ECMO or total artificial heart transplantation.Conclusion The main causes of high-rate cases include complex and severe cases,operational errors of doctors and coders,over-treatment,and the practice of"under-coding with over-charging".To effectively control the number of high-rate cases,improve the quality of medical services,and alleviate the economic pressure on hospitals,the following countermeasures were proposed:improving medical insurance supporting policies,strengthening the training of medical teams,promoting the construction of information technology,formulating clinical pathways,and reinforcing medical supervision.

Objective To analyze the causes of high-rate DRG cases and to propose effective management countermeasures to address the challenges posed by high-rate cases to the economy of hospitals and the quality of medical services.Methods Data of 6 937 high-rate cases and 120 782 normal-rate cases were analyzed using Excel 2021,and the causes of high-rate cases were analyzed in conjunction with the results of medical quality inspections.Results High-rate cases exhibit significantly higher average benchmark points and per capital hospitalization costs compared to normal cases,especially those with benchmark points exceeding 300,where the average cost reaches up to 151 906.70 yuan.The high-rate cases were concentrated in the group of complex diseases such as invasive ventilator support ≥96 hours or ECMO or total artificial heart transplantation.Conclusion The main causes of high-rate cases include complex and severe cases,operational errors of doctors and coders,over-treatment,and the practice of"under-coding with over-charging".To effectively control the number of high-rate cases,improve the quality of medical services,and alleviate the economic pressure on hospitals,the following countermeasures were proposed:improving medical insurance supporting policies,strengthening the training of medical teams,promoting the construction of information technology,formulating clinical pathways,and reinforcing medical supervision.

The process of establishing and improving the Employee Health Insurance Outpatient Co-payment Protection Mecha-nism is one of the major livelihood projects to deepen the reform of China's medical insurance system.The implementation of the mu-tual-aid mechanism for covering outpatient bills in each coordinating region is accompanied by the risks of squeezing outpatient medi-cal resources,the prevalence of fraud and deception,the increase of the government s economic burden and the lack of public ac-ceptance.In this regard,suggestions are made to improve the policy:open source and cut costs to make up for the shortage of funds,linkage of three medical institutions to build a medical security pattem,coordinated supervision to maintain the stability of medical insurance funds,and optimized policies to promote the reform of medical insurance payment methods.

The reform of public hospital salary system is an important part of China's medical and health system reform,and it is also the key and difficult point to be solved in the high-quality development of public hospitals.Through literature research and comparative analysis,it sorts out the reform process of China's public hospital salary system and the salary status of medical personnel,and compares the differences between the salary systems of public hospitals in some developed countries;Some difficult problems exist in this field,such as insufficient and unbalanced government financial investment,weak guarantee of salary system,low salary level of medical personnel and unrea-sonable internal gap,and unscientific performance appraisal distribution.Countermeasures and suggestions are put forward from five aspects:strengthening government financial input,implementing system guarantee,improving performance appraisal and distribution system,non-economic compensation,and strengthening information sup-port,so as to provide reference for further improving the reform effect.

American medical education is one of the most characteristic and successful education models in the western country. There are significant differences between American and Chinese medical education. American successful experiences are precious for China to build the first-class medical universities in the new century