Ten Years Reform of Simplified DRG-based Hospital Payment System:A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 CUIQing-chuan ¹ ,  WANGZhao-xin ² ^* ,  JIANGWei ¹ ^*

1. Antal Economics-Management College, Shanghai JiaoTong University, Shanghai 200030, China;
2. Medical School of TongJi University, Shanghai 200092, China;

Corresponding author：

WANGZhao-xin, Email: supercell002@sina.com; JIANGWei, Email: jiangwei@sjtu.edu.cn

Keywords：

Case-based Payment; Simplified DRGs; Evaluation

DOI：

10.7507/1672-2531.20160168

Video：

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Objective As few studies have evaluated the policy effects of the Chinese simplified DRGs-PPS systematically, this research aims to assess its policy effects and to provide insight for other developing regions that are undergoing the same reform. Methods The history and major problems of the Chinese DRGs-PPS were analyzed qualitatively. Moreover, the efficiency (average hospitalization cost; length of stay, LOS) and equity of the simplified DRGs-PPS were examined at both macro and micro levels. Results As of today, only 20 of the 32 provinces in mainland China had implemented the simplified DRGs. There were also huge differences in terms of the number and categories of diseases among the various provinces involved. Literature review showed that " lack of rationale in setting payment standards" , "limited diseases are included into the DRGs categories" and "lack of regulation to avoid ethical risks of health service providers" were the frequently cited problems. On the macro level, the national average medical cost had increased while the average LOS had been relatively stable from the year 2004 onwards, and simplified DRGs had been implemented widely since 2004 while discrepancies existed in various provinces. On the micro level, among the studies that focused on assessing hospitals with statistical test, 78% (11/14) of these studies revealed that hospitalization cost could be reduced and 60% (6/10) of them indicated that LOS could be reduced. Conclusion By comparing the policy effects at both macro and micro levels, we conclude that the simplified DRGs are useful in controlling hospitalization cost but they fail to reduce LOS. Also much more still needs to be done in China to facilitate the transition from simplified DRGs to genuine DRGs.

Citation： CUIQing-chuan, WANGZhao-xin, JIANGWei. Ten Years Reform of Simplified DRG-based Hospital Payment System:A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2016, 16(9): 1104-1111. doi: 10.7507/1672-2531.20160168 Copy

1.	Yoo RN, Chung C, Kim J. Evaluating the efficacy of the current diagnosis-related group reimbursement system for laparoscopic appendectomy at a single institute in Korea. Ann of Sur Treat and Res, 2014, 87(3): 148.
2.	DRG-based payment systems in low-and middle income countries: Implementation experiences and challenges. Available at: http://who.int/health_financing/documents/cov-dp_e_10_02-drg_systems/en/.
3.	王淑红, 陆岷, 张秋菊, 等.运用单病种核算及住院费用最高限价控制医药费用增长.中国卫生经济, 2003, 22(8): 27.
4.	万华军, 肖嵩, 罗五金, 等.我国单病种付费定义和理解误区之探讨.中国卫生经济, 2008, 27(12): 49-51.
5.	黄玉珊, 曾林淼, 李幼平, 等.我国农村卫生改革政策系统回顾及绩效评价研究.中国循证医学杂志, 2012, 12(3): 293-304.
6.	王小万. DRGs方法与原理评价.国外医学社会医学分册, 1990, 7(2): 53-56.
7.	马骏. DRGs系统新模式的研究.中国医院管理, 1994, 14(9): 11-13.
8.	刘先琴, 李可.河南试行按病种付费制度.光明日报. 2006-08-13.
9.	简伟研, 胡牧, 简伟健, 等.基于"诊断相关组"评估医院诊疗技术的综合能力.中国医院管理, 2010, 2008): 17-19.
10.	卫生部.关于印发第二批单病种质量控制指标的通知. Available at: http://www.gov.cn/gzdt/2010-12/13/content_1764678.htm.
11.	国务院办公厅.关于印发医药卫生体制五项重点改革2011年度主要工作安排的通知. Available at: http://www.gov.cn/zwgk/2011-02/17/content_1805068.htm.
12.	邢建丽, 姚仲玲.北京大学第一医院结节性甲状腺肿住院费用的影响因素分析.北京:北京大学, 2005.
13.	张银华, 何国平, 陈燕, 等.不同医疗保险付费方式对急性单纯性阑尾炎患者住院费用的影响研究.中国全科医学, 2015(13): 1580-1582.
14.	李婷婷, 顾雪非, 冯奥, 等.常熟市新农合按病种付费实施效果分析.中国卫生经济, 2010, 29(5): 46-48.
15.	李建业, 朱滨海.新农合患者按病种付费前后质控指标对比研究.江苏卫生事业管理, 2015, 26(4): 15-18.
16.	罗石梅, 袁丽萍.新农合肿瘤单病种限价试行体会.现代医院管理, 2014, 12(5): 56-58.
17.	周丽, 张超, 叶奎英.扬州市邗江区新农合按病种结算的探索.卫生经济研究, 2012, 23(1): 29-31.
18.	张明敏.按病种结算探析.卫生经济研究, 2014, 25(8): 52-54.
19.	陈小娟.高邮市新型农村合作医疗住院支付方式改革研究.南京:南京医科大学, 2012.
20.	李荣艳, 吴晓红, 孙国梅.加强新农合按病种付费方式管理的探讨.安徽卫生职业技术学院学报, 2013, 32(6): 1-2.
21.	胡大洋, 冷明祥, 夏迎秋, 等.江苏省三种基本医疗保险支付方式改革与探索.中国医院管理, 2011, 31(2): 48-51.
22.	张月林, 卜秋, 于可人, 等.苏州市调整扩大城乡居民基本医疗保险住院按病种结算调查报告.中国初级卫生保健, 2009, 15(12): 39-44.
23.	徐慧珍, 毛巧贤, 张玉成, 等.按单病种支付标准控制住院费用的试点效果评价.中国卫生资源, 2006, 25(1): 38-39.
24.	陈明, 郭岩.单病种付费对住院分娩服务提供方行为的影响.北京大学学报(医学版), 2012, 67(3): 387-391.
25.	雷惠东.按病付费能否降低个人就医负担?--天津市某三甲医院病种付费试点效果分析.天津社会保险, 2014, 8(5): 31-32.
26.	宋晓平.城镇居民以临床路径为基础单病种付费的成效分析.新疆医学, 2011, 67(11): 116-119.
27.	陈钟涛, 吴起武.单病种付费前后急性阑尾炎住院费用分析.海南医学, 2014, 14(2): 273-275.
28.	李美连, 骆庆明.三种支付方式对急性阑尾炎治疗方式及医疗费用的影响.中国卫生统计, 2014, 13(1): 90-92.
29.	王莉云.单病种结节性甲状腺肿手术付费效果评价.中国病案, 2013, 21(12): 54-56.
30.	陈钟涛.单病种实施前后股骨颈骨折患者住院费用情况分析.当代医学, 2014, 17(20): 44-46.
31.	刘学才, 李霞, 史芳, 等.儿童重大疾病按病种付费运行分析.医学信息学杂志, 2013, 34(5): 66-70.
32.	沈慧, 沈定华, 李峰, 等.合肥市某三甲医院新农合重大疾病按病种付费实施效果分析.泰山医学院学报, 2014(11): 1114-1116.
33.	芦丰, 宋静, 孙晓阳, 等.淮安市按病种分值付费的实证研究.南京医科大学学报(社会科学版), 2014, 43(4): 280-283.
34.	郭燕飞, 冷明祥, 万彬.金坛市人民医院按病种付费实施效果研究.南京医科大学学报(社会科学版), 2014, 32(4): 284-288.
35.	陈栋.上海市闵行区农村合作医疗按病种定额付费的实施效果研究.上海:复旦大学, 2009.
36.	Kim H, Jung I M, Yun K W, et al. Early outcome of the Korean Diagnosis-Related Groups payment system for appendectomy. Ann of Sur Treat and Res, 2015, 88(3): 126.
37.	Christaras A, Schaper J, Strelow H, et al. Effects of self-adapting G-DRG system 2004 to 2006 on in-patient services payment in pediatric hematology and oncology patients of a university hospital. Klinische Padiatrie, 2006, 218(6): 366-378.

1. Yoo RN, Chung C, Kim J. Evaluating the efficacy of the current diagnosis-related group reimbursement system for laparoscopic appendectomy at a single institute in Korea. Ann of Sur Treat and Res, 2014, 87(3): 148.
2. DRG-based payment systems in low-and middle income countries: Implementation experiences and challenges. Available at: http://who.int/health_financing/documents/cov-dp_e_10_02-drg_systems/en/.
3. 王淑红, 陆岷, 张秋菊, 等.运用单病种核算及住院费用最高限价控制医药费用增长.中国卫生经济, 2003, 22(8): 27.
4. 万华军, 肖嵩, 罗五金, 等.我国单病种付费定义和理解误区之探讨.中国卫生经济, 2008, 27(12): 49-51.
5. 黄玉珊, 曾林淼, 李幼平, 等.我国农村卫生改革政策系统回顾及绩效评价研究.中国循证医学杂志, 2012, 12(3): 293-304.
6. 王小万. DRGs方法与原理评价.国外医学社会医学分册, 1990, 7(2): 53-56.
7. 马骏. DRGs系统新模式的研究.中国医院管理, 1994, 14(9): 11-13.
8. 刘先琴, 李可.河南试行按病种付费制度.光明日报. 2006-08-13.
9. 简伟研, 胡牧, 简伟健, 等.基于"诊断相关组"评估医院诊疗技术的综合能力.中国医院管理, 2010, 2008): 17-19.
10. 卫生部.关于印发第二批单病种质量控制指标的通知. Available at: http://www.gov.cn/gzdt/2010-12/13/content_1764678.htm.
11. 国务院办公厅.关于印发医药卫生体制五项重点改革2011年度主要工作安排的通知. Available at: http://www.gov.cn/zwgk/2011-02/17/content_1805068.htm.
12. 邢建丽, 姚仲玲.北京大学第一医院结节性甲状腺肿住院费用的影响因素分析.北京:北京大学, 2005.
13. 张银华, 何国平, 陈燕, 等.不同医疗保险付费方式对急性单纯性阑尾炎患者住院费用的影响研究.中国全科医学, 2015(13): 1580-1582.
14. 李婷婷, 顾雪非, 冯奥, 等.常熟市新农合按病种付费实施效果分析.中国卫生经济, 2010, 29(5): 46-48.
15. 李建业, 朱滨海.新农合患者按病种付费前后质控指标对比研究.江苏卫生事业管理, 2015, 26(4): 15-18.
16. 罗石梅, 袁丽萍.新农合肿瘤单病种限价试行体会.现代医院管理, 2014, 12(5): 56-58.
17. 周丽, 张超, 叶奎英.扬州市邗江区新农合按病种结算的探索.卫生经济研究, 2012, 23(1): 29-31.
18. 张明敏.按病种结算探析.卫生经济研究, 2014, 25(8): 52-54.
19. 陈小娟.高邮市新型农村合作医疗住院支付方式改革研究.南京:南京医科大学, 2012.
20. 李荣艳, 吴晓红, 孙国梅.加强新农合按病种付费方式管理的探讨.安徽卫生职业技术学院学报, 2013, 32(6): 1-2.
21. 胡大洋, 冷明祥, 夏迎秋, 等.江苏省三种基本医疗保险支付方式改革与探索.中国医院管理, 2011, 31(2): 48-51.
22. 张月林, 卜秋, 于可人, 等.苏州市调整扩大城乡居民基本医疗保险住院按病种结算调查报告.中国初级卫生保健, 2009, 15(12): 39-44.
23. 徐慧珍, 毛巧贤, 张玉成, 等.按单病种支付标准控制住院费用的试点效果评价.中国卫生资源, 2006, 25(1): 38-39.
24. 陈明, 郭岩.单病种付费对住院分娩服务提供方行为的影响.北京大学学报(医学版), 2012, 67(3): 387-391.
25. 雷惠东.按病付费能否降低个人就医负担?--天津市某三甲医院病种付费试点效果分析.天津社会保险, 2014, 8(5): 31-32.
26. 宋晓平.城镇居民以临床路径为基础单病种付费的成效分析.新疆医学, 2011, 67(11): 116-119.
27. 陈钟涛, 吴起武.单病种付费前后急性阑尾炎住院费用分析.海南医学, 2014, 14(2): 273-275.
28. 李美连, 骆庆明.三种支付方式对急性阑尾炎治疗方式及医疗费用的影响.中国卫生统计, 2014, 13(1): 90-92.
29. 王莉云.单病种结节性甲状腺肿手术付费效果评价.中国病案, 2013, 21(12): 54-56.
30. 陈钟涛.单病种实施前后股骨颈骨折患者住院费用情况分析.当代医学, 2014, 17(20): 44-46.
31. 刘学才, 李霞, 史芳, 等.儿童重大疾病按病种付费运行分析.医学信息学杂志, 2013, 34(5): 66-70.
32. 沈慧, 沈定华, 李峰, 等.合肥市某三甲医院新农合重大疾病按病种付费实施效果分析.泰山医学院学报, 2014(11): 1114-1116.
33. 芦丰, 宋静, 孙晓阳, 等.淮安市按病种分值付费的实证研究.南京医科大学学报(社会科学版), 2014, 43(4): 280-283.
34. 郭燕飞, 冷明祥, 万彬.金坛市人民医院按病种付费实施效果研究.南京医科大学学报(社会科学版), 2014, 32(4): 284-288.
35. 陈栋.上海市闵行区农村合作医疗按病种定额付费的实施效果研究.上海:复旦大学, 2009.
36. Kim H, Jung I M, Yun K W, et al. Early outcome of the Korean Diagnosis-Related Groups payment system for appendectomy. Ann of Sur Treat and Res, 2015, 88(3): 126.
37. Christaras A, Schaper J, Strelow H, et al. Effects of self-adapting G-DRG system 2004 to 2006 on in-patient services payment in pediatric hematology and oncology patients of a university hospital. Klinische Padiatrie, 2006, 218(6): 366-378.

Chinese Journal of Evidence-Based Medicine

Ten Years Reform of Simplified DRG-based Hospital Payment System:A Systematic Review

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