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DRG支付方式下病案高编码对医保支付的影响及特征探究

Investigation into the Impact and Characteristics of Overcoding in Medical Records on Insurance Reimbursement under the DRG Payment System

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【作者】 邢维荣; 张俊全; 秦超; 张怡;

【Author】 Xing Weirong;Zhang Junquan;Qin Chao;Medical Record Department, Tianjin Haihe Hospital;

【通讯作者】 秦超;

【机构】 天津市海河医院病案科;

【摘要】 在医疗费用控制与医疗服务效率提升的背景下,DRG支付方式作为先进的医疗保险支付机制,在全球范围内被广泛应用。DRG支付方式的核心在于将患者根据其临床诊断、治疗过程及资源消耗因素归类至不同的疾病诊断相关组,从而实现按组付费而非按服务项目逐一计费。这种方式旨在通过标准化支付标准,减少过度医疗,优化医院运营效率和服务质量。

【Abstract】 Under the background of controlling healthcare costs and improving the efficiency of medical services, Diagnosis Related Group(DRG) payment systems, as an advanced health insurance payment mechanism, have been widely adopted globally.The core of DRG payment lies in categorizing patients into different diagnosis-related groups based on their clinical diagnosis,treatment process, and resource consumption factors. This enables payment by group rather than billing for each individual service item. This approach aims to reduce overmedicalization and optimize hospital operational efficiency and service quality through standardized payment criteria.

  • 【文献出处】 黑龙江医学 ,Heilongjiang Medical Journal , 编辑部邮箱 ,2026年03期
  • 【分类号】R197.323
  • 【下载频次】15
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