国家卫生计生委卫生发展研究中心 China National Health Development Research Center http://www.nhdrc.cn 中国按疾病诊断相关分组收(付)费规范的研制与展望 于丽华 Yu Lihua 国家卫生计生委卫生发展研究中心 National Health Development Research Center, NHFPC 2015年10月,巴黎 Oct.2015, Paris Development and prospects for pricing and payment regulation on China’s diagnosis-related groups (CN-DRG)
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中国按疾病诊断相关分组收(付)费规范的研制与展望...Brief Introduction of CN-DRG Development by CNHDRC •...
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国家卫生计生委卫生发展研究中心 China National Health Development Research Center
http://www.nhdrc.cn
中国按疾病诊断相关分组收(付)费规范的研制与展望
于丽华 Yu Lihua
国家卫生计生委卫生发展研究中心 National Health Development Research Center, NHFPC
2015年10月,巴黎 Oct.2015, Paris
Development and prospects for pricing and payment
regulation on China’s diagnosis-related groups (CN-DRG)
一、中国支付制度改革背景介绍
Background of Payment System Reform in China
二、中法双方前期在DRG领域的合作
China France Previous Cooperation in DRG Development
三、中国DRG收(付)费系统开发简介 Brief Introduction of CN-DRG Development by CNHDR
四、中法未来合作展望
Prospects for Future Cooperation between CNHDRC and French Counterparts
内 容 Outline
一、中国支付制度改革背景介绍
Background of Payment System Reform in China
当前全国公立医院经济总体运行特点与问题Characteristics of economic operation of health facilities
1.由于政府财政对医院(公立医院)补偿不足,医疗服务的价格低于成本价
格,“以药补医”成为当前公立医院补偿机制的主要特征。
Due to insufficient government subsidy for public hospitals, prices are below cost price for
medical procedures and service, the "over-description of drugs compensation for medical costs”
mechanism becomes the main feature of public hospitals.
2. 我国医院实行按项目付费,技术劳务价格偏低,难以调到合理水平。医
院趋利行为造成大处方、大检查较为普遍,费用控制成为难题。
FFS is the major hospital payment method in China, Low prices of health procedures and
labor which are hard to redress to reasonable levels. Profit-driven behavior results in abuse of
drugs, lab tests and consumables, cost containment is a big challenge.
3.医疗机构的补偿过多地依靠药品和耗材收入。 Health institution reimbursement over-depends on revenues from medicine and consumable
materials
--对现行的医院支付制度进行改革成为当前我国医改的主要任务之一。 The provider payment system reform has become one of the main tasks of the current health
care reform.
我国支付方式改革演进策略 Evolution of payment reform in China
简单单病种付费 Per case for simple
illness
DRG
第一阶段
Stage 1
第二阶段
Stage 2
第三阶段
Stage 3
按项目付费FFS
按住院床日付费
Per diem
按住院单元付费
Per episode
按人头付费Capitation
按项目付费FFS
其他付费方式
Other methods
按服务项目打包付费(项目规范)
FFS for bundles services(Fee Schedule)
复杂单病种付费 Per case for
complex conditions
公立医院支付制度改革趋势 Trends of PPM reform in public hospitals
• 趋势:从按项目付费到按人头、按病种、按床日付费最终发展成为“住院支
付以DRG为主,按项目、按床日和按人头多种支付方式并存”的体系。
Trend: PPM will be transformed from FFS, capitation, per diem, case payment to mixed
payment system dominated by DRG, together with FFS, per diem and capitation.
• 创建一个具有自主知识产权的“中国DRG收(付)费体系”成为医改重要内
容。
To develop CN-DRG with our own intellectual property rights has become one of the important
part of the current health care reform.
法国DRG体系 DRG System in France
• 法国是世界上在全国范围内推行DRG支付医疗费用最成功的国家之一。
France is one of the most successful counties in DRG payment system.
• 法国卫生部医疗服务总局是法国推行DRG支付医疗费用的领导部门,该部下
属的医院保健信息分局(ATIH)是法国负责研究与实施DRG的核心研究与管
理机构,在DRG定价、支付和监管领域有着丰富的经验,对我国开发DRG系
统、实施、监管(含医院质量管理)与评价有着重要的参考价值和借鉴意义
。
DGOS is the leader department of GHM in France, ATIH is the key research and management
institute responsible for the DRG research and implementation, which has rich experiences on
DRG pricing, payment and monitoring field and make valuable references for our CN- DRG
design,practice, investigate(including hospital quality management) and evaluation.
二、中法双方前期在DRG领域的合作
China France Previous Cooperation in DRGs Development
卫生发展研究中心自2009年起与法国卫生部建立了友好合作关系。 Since 2009, CHNDRC has set up good relationship with MOH of France.
Jun. 2010, CNHDRC held DRG Research and Implementation Summit , Félix Faucon from French Ministry of Health delivered a speech on “French Health Payment System Reform and Implementation” .
• 2010年11月,卫生发展研究中心与法国卫生部医疗服务总局共同签署
了“关于卫生筹资、医院信息系统和卫生政策评估领域的合作谅解备忘
录” Nov, 2010, NHDRC signed the MOU of the “Cooperation in health care financing,hospital
information system and health policy evaluation “with MOH of France.
----双方主要合作领域包括共同开展医院补偿与筹资体系、医疗信息分类与编码
、医院成本核算研究;共同开展卫生领域培训项目,并交换访问学者和专家 The main area of cooperation includes: research on hospital reimbursement and financing,
classification and coding of health information, cost-accounting of hospital as well as
training program in health care system and exchange of experts and scholars .
Dec. 2010, Experts from French Ministry of Health visited Beijing and worked together with staff from NHFPC and CNHDRC to develop the report on “Health system reform in France, experiences and lessons to health reform in China” . The report were submitted to NHFPC
Prospects for Future Cooperation between CNHDRC and
French Counterparts
四、中法未来合作展望 Prospects for Future Cooperation between CNHDRC and French
Counterparts
• 希望DRG研究与支持项目变成一个持久合作项目,在前期
两国部级合作的基础上,上升到中法国家层面的合作。
Hope DRG Project become a long-lasting national-level cooperation projects between the two countries on the basis of pre-ministerial cooperation.
• 希望得到法国相关机构和专家们一始既往的支持。
Hope to get ongoing support from French agencies and experts.
– DRG的政策制定、推广、应用领域、制度建设(财务、医保、质量管理)、管理流程、师资培训。
DRG policy development, roll-up, applications, system construction (financing, health insurance, quality management), management processes, training of trainers.
– 在实践DRG时,如何确定医疗服务、药品和耗材的定价和价格调整机制。
When practicing DRG, how to set pricing and price adjustment mechanism of medical procedures and services, drugs and medical devices.