DIP支付改革下公立医院绩效分配机制的探讨

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关键词：公立医院；DIP支付改革；医院绩效分配；成本核算；设计思路中图分类号：R197.322文献标志码：A 文章编号：1001-5779（2025）09-0886-06DOI：10.3969/j.issn. 1001-5779.2025.09.012

Abstract：Toanalyze the problems in performancealocationunderdiagnosis-interventionpacket（DIP）paymentreformin public hospitals，including thedisconnectionbetweentheperformanceevaluationsystemand DIPpaymentobjectives，the lack of coordinationbetween cost managementand DIP payment，，and the imbalancebetween performance incentives and medical quality indicators.Toexploring corresponding measures toaddresstheissueofperformanceallcation，ncluding establishing a refined performance evaluation system corresponding to DIP payment targets，promoting thecoordinated developmentofcostmanagementandDIPpaymentfordiseasecostcontrol，implementingperformancealocationbasedon thethree-dimensionalbalanceof "qualityeficiencycost".Itisproposed to formulateideas forperformanceallocation schemes in public hospitalsunder DIPpaymentreform，including the basic ideasand principles of design，theoverall framework，asessment content，implementationof the plan，etc.Finally，reflections and prospects have beengivenon the performance management of public hospitals under the DIP payment reform.

Key Words：Public hospitals；DIP payment reform；Hospital performance allocation; Costing；Design concept

自1983年起，美国医院住院费用开始采用诊断相关分组（Diagnosis-related groups，DRG）支付（后升级为MS-DRG），随后世界许多国家的医院相继进行医疗改革，如德国的动态调整分组体系（German diagnosis-related groups，G-DRG）、英国的医疗资源组支付（Healthcareresourcegroups，HRG）、日本的诊断程序组合（Diagnosisprocedurecombination，DPC）、中国的按病种分值付费（Diagnosis-intervention packet，DIP）等。（剩余7655字）