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鐜嬬劚
(澶╂触甯傚偝鏌撶梾閱�(y墨)闄㈢梾妗堝澶╂触300192)
銆愭憳瑕併€戠柧鐥呰ê鏂风浉闂�(gu膩n)鍒嗙祫(DRGs)琚唬娉涜瓑鏄庢噳(y墨ng)鐢ㄤ簬閱�(y墨)鐧備繚闅�(xi菐n)鏀粯鍒跺害涓皪(du矛)鎺у埗閱�(y墨)鐧傝不(f猫i)鐢ㄤ笉鍚堢悊鐨勪笂婕插叿鏈夐噸瑕佺殑鐝�(xi脿n)瀵�(sh铆)鎰忕京銆傛枃绔犱粙绱�DRGs鍦ㄦ垜鍦�(gu贸)閱�(y墨)鐧備繚闅�(xi菐n)闋�(l菒ng)鍩熺殑瀵�(sh铆)韪愮媭娉佺殑鍩虹(ch菙)涓�, 绲�(ji茅)鍚堝湅(gu贸)澶栫稉(j墨ng)椹�(y脿n), 灏�(du矛)鍒跺畾涓湅(gu贸)鐗�DRGs閫�(j矛n)琛屼簡鎺㈡瀽, 鎻愬嚭鍦ㄩ啱(y墨)鐧備繚闅�(xi菐n)鍒跺害涓(sh铆)鏂�DRGs鏀粯鏂瑰紡鐨勮榛�(di菐n)浠ュ強鐩搁棞(gu膩n)鐨勮В姹哄皪(du矛)绛�, 鍗抽€氶亷(gu貌)瑕�(gu墨)鑼冪柧鐥呰ê鏂峰拰绶ㄧ⒓銆佸埗瀹氳嚚搴婅ê鐧傝(gu墨)鑼�銆佸缓绔嬬瀛�(xu茅)鐨勭梾绋垚鏈牳绠楃郴绲�(t菕ng)鍜屽畬鍠勯啱(y墨)鐧傝唱(zh矛)閲忕洠(ji膩n)鐫ｆ(j墨)鍒�, 瀵�(sh铆)鐝�(xi脿n)DRGs鍦ㄦ垜鍦�(gu贸)閱�(y墨)鐧備繚闅�(xi菐n)鏀粯鍒跺害涓殑鎳�(y墨ng)鐢�銆�
銆愰棞(gu膩n)閸佃銆戠柧鐥呰ê鏂风浉闂�(gu膩n)鍒嗙祫(DRGs)锛涙敮浠樻柟寮忥紱閱�(y墨)鐧傝不(f猫i)鐢�
銆愪腑鍦栧垎椤炶櫉(h脿o)銆�R197.3銆愭枃鐛�(xi脿n)妯�(bi膩o)璀�(sh铆)纰笺€�A銆愭枃绔犵法铏�(h脿o)銆�1008-6455锛�2010锛�08-0417-02
        杩戝咕鍗佸勾渚�(l谩i), 濡備綍瑙ｆ焙绋€缂虹殑琛�(w猫i)鐢熻硣婧愯垏閱�(y墨)鐧傝不(f猫i)鐢ㄧ殑楂橀€熷闀�(zh菐ng)鐨勬矕绐佸凡缍�(j墨ng)鎴愮偤涓栫晫鍚勫湅(gu贸)闈㈣嚚鐨勬櫘閬嶉洠椤�, 瑷卞鍦�(gu贸)瀹堕兘鍦ㄧ⿳妤靛皨姹傝兘澶犳帶鍒惰(w猫i)鐢熻不(f猫i)鐢ㄥ闀�(zh菐ng)鐨勬湁鏁堥€斿緫銆備笂涓栫磤(j矛)80 骞翠唬, 缇庡湅(gu贸)鐮斿埗鍑轰竴绋熀浜庣柧鐥呰ê鏂风浉闂�(gu膩n)鍒嗙祫(Diagnosis Related GroupSystem, DRGs)鐐哄熀绀�(ch菙)鐨勯爯(y霉)瀹氶浠樿不(f猫i)鏂瑰紡(ProspectivePayment System, PPS),灏囧偝绲�(t菕ng)鐨勫(sh铆)鍫�(b脿o)瀵�(sh铆)閵�(xi膩o)鐨勫悗浠樺埗杞�(zhu菐n)璁�?y艒u)杞瑼(y霉)浠樺埗,瀵�(sh铆)韪愯瓑鏄庨€欑ó鏂瑰紡鍦ㄦ帶鍒朵笉鍚堢悊璨�(f猫i)鐢ㄥ闀�(zh菐ng)鍜岄亷(gu貌)搴﹂啱(y墨)鐧傛湇鍕�(w霉)闇€姹備笂鐧�(f膩)鎻簡绌嶆サ鐨勪綔鐢�[1]銆傛鍚�,涓嶅皯鍦�(gu贸)瀹跺潎鍦ㄦ鍩虹(ch菙)涓婃帰绱㈤仼鍚堟湰鍦�(gu贸)鍦�(gu贸)鎯呯殑DRGs-PPS浠樿不(f猫i)鍒跺害銆�
        1DRGs鍦ㄥ湅(gu贸)澶栫殑鎳�(y墨ng)鐢ㄥ強鐧�(f膩)灞�
        鐤剧梾瑷烘柗鐩搁棞(gu膩n)绲�(Diagnosis Related Group System DRGs)鏄竴绋梾渚嬬祫鍚堟柟寮�,瀹冪稖鍚堣€冩叜鐥呬緥涓昏瑷烘柗銆侀檮鍔犺ê鏂�銆佹墜琛�(sh霉)銆佸苟鐧�(f膩)鐧�/鍚堝苟鐧�銆佸勾榻�銆佸叆闄㈡儏娉�銆佸嚭闄㈣綁(zhu菐n)姝哥瓑璜稿鍥犵礌鐨勫奖闊�,灏�(du矛)鐥呬緥閫�(j矛n)琛屽垎椤炵祫鍚堟垚鑻ュ共瑷烘柗鐩搁棞(gu膩n)绲�,姣忎竴绲勯兘鏈夎純楂樼殑鍚岃唱(zh矛)鎬�,鏈夎憲鐩稿悓鐨勮(w猫i)鐢熻硣婧愭秷鑰�,缍�(j墨ng)閬�(gu貌)瓒呭ぇ妯ｆ湰閲忕殑鐮旂┒,鍒跺畾鍑烘瘡绲勭梾渚嬬殑鏀粯妯�(bi膩o)婧�(zh菙n),绲�(ji茅)鍚堥爯(y霉)浠樿不(f猫i)鍒跺害,鎮ｈ€呭埌閱�(y墨)鐧傛(j墨)妲�(g貌u)灏辫ê,鍚戠涓夋柟(濡傞啱(y墨)淇濋儴闁€(m茅n))鏀粯涓€瀹氱殑璨�(f猫i)鐢�,鐢辩涓夋柟鍚戦啱(y墨)鐧傛(j墨)妲�(g貌u)鎸夋偅鑰呯殑DRGs鍒嗙祫浠樿不(f猫i),鏀规寜闋�(xi脿ng)鐩粯璨�(f猫i)鐐烘寜鐤剧梾瑷烘柗鐩搁棞(gu膩n)绲勪粯璨�(f猫i),寰炶€屾湁鏁堝湴鍒剁磩閱�(y墨)闄㈢殑閱�(y墨)鐧傝鐐�,婵€鍕�(l矛)閱�(y墨)闄㈤檷浣庢垚鏈�,娓涘皯琛�(w猫i)鐢熻硣婧愮殑娴不(f猫i),閬�(d谩)鍒版帶鍒堕啱(y墨)鐧傝不(f猫i)鐢ㄧ殑鐩殑[2銆�3]銆�
        1.1DRGs婧愪簬缇庡湅(gu贸)銆傛渶鍒�DRGs鏄皣閱�(y墨)闄㈢壒瀹氱梾绋垏鍏舵墍娑堣€楅啱(y墨)鐧傝不(f猫i)鐢ㄨ伅(li谩n)绯昏捣渚�(l谩i)鐨勪粯璨�(f猫i)鏂规,鏄敤浜庢牴鎿�(j霉)娑堣不(f猫i)姘村钩鍜岀梾鎯呯浉浼肩▼搴﹀皣浣忛櫌鐥呬汉鍒嗙祫鐨勭郴绲�(t菕ng)銆傜敱浜庡湪閱�(y墨)鐧傛湇鍕�(w霉)甯傚牬(ch菐ng)涓瓨鍦ㄨ憲鍤�(y谩n)閲嶇殑淇℃伅涓嶅皪(du矛)绋�,鍑虹従(xi脿n)浜嗚獦灏�(d菐o)闇€姹�,鍗抽渶鏂硅鍕�(d貌ng)鍜屼緵鏂瑰鏂锋€�,閱�(y墨)鐢熸帉鎻＄殑灏堟キ(y猫)淇℃伅鍦ㄥ緢澶х▼搴︿笂鏈�(hu矛)褰遍熆鐢氳嚦姹哄畾娑堣不(f猫i)鑰呯殑閬告搰銆傞啱(y墨)闄㈤噷澶х磩80%锝�90%鑸囩稉(j墨ng)婵�(j矛)鐩搁棞(gu膩n)鐨勬焙瀹氭槸鐢遍啱(y墨)鐢熷仛鍑虹殑[4]銆傝獦灏�(d菐o)闇€姹傛渻(hu矛)灏�(d菐o)鑷撮啱(y墨)鐧傝硣婧愬埄鐢ㄧ殑涓嶅叕骞�銆佷綆鏁堢巼鍜岄亷(gu貌)蹇闀�(zh菐ng),閲濆皪(du矛)閫欎竴鍟�(w猫n)椤�,缇庡湅(gu贸)鍦�(gu贸)瀹惰(w猫i)鐢熺睂璩囩鐞嗗眬浜�1983骞存噳(y墨ng)鐢ㄦ寜鐤剧梾瑷烘柗鐩搁棞(gu膩n)鍒嗙祫鈥斺€�闋�(y霉)浠樻鍒跺害浠樿不(f猫i)鏂瑰紡銆傝┎绯荤当(t菕ng)鍦ㄥ叕骞虫湁鏁堝湴鍒嗛厤鍜岀鐞嗚(w猫i)鐢熻硣婧愭柟闈㈠仛鍑轰簡宸ㄥぇ璨㈢嵒(xi脿n), 琚笘鐣屼笂瑷卞鍦�(gu贸)瀹跺€熼憭鐐洪啱(y墨)鐧傝(w猫i)鐢熸敮鍑虹殑渚濇摎(j霉)[5]銆�
        1.2鑻卞湅(gu贸)灏�(du矛)DRGs鐨勭爺绌躲€傝嫳鍦�(gu贸)鐨勭梾渚嬬祫鍚堢爺绌堕枊(k膩i)濮嬩簬1986骞�,鍦ㄩ€�(j矛n)琛屾繁鍏ョ窗(x矛)鑷寸爺绌跺悗,褰㈡垚琛�(w猫i)鐢熶繚鍋ヨ硣婧愬垎椤炴硶(Health- care Resource Groups, HRGs),涓昏鐢ㄤ簬琛�(w猫i)鐢熻硣婧愮殑绠＄悊鍜岄啱(y墨)鐧傜殑瑭�(p铆ng)鍍�(ji脿)銆傚埌1997骞�, HRGs宸茬稉(j墨ng)鎺ㄥ嚭浜嗙3浠ｇ増鏈�,鍏剁梾渚嬩笉鍍呭儏灞€闄愪簬浣忛櫌鐥呬汉,鎬ヨê鐥呬汉鍜岄杸(m茅n)瑷虹梾浜轰害琚垎闁€(m茅n)鍒ラ閫�(j矛n)琛岀祫鍚堢爺绌�[6]銆�
        1.3DRGs鍦ㄦ境澶у埄浜炵殑鎳�(y墨ng)鐢ㄨ垏鐧�(f膩)灞�銆傛境澶у埄浜炲緸1984骞�2鏈堥枊(k膩i)濮嬪(sh铆)琛屼竴绋ū鐐�鈥�鍦�(gu贸)瀹堕啱(y墨)鐧傜収椤у埗鈥�鐨勫叏姘戦啱(y墨)鐧備繚闅�(xi菐n)瑷�(j矛)鍔�銆傛牴鎿�(j霉)閫欎竴閱�(y墨)鐧備繚闅�(xi菐n)瑷�(j矛)鍔�,鎵€鏈夌殑婢冲ぇ鍒╀簽灞呮皯閮藉彲鍏嶈不(f猫i)浜彈閱�(y墨)闄㈤啱(y墨)鐧傛湇鍕�(w霉),鐥呬汉鍦ㄥ叕绔嬮啱(y墨)闄㈢殑璨�(f猫i)鐢ㄩ兘涓嶉渶鑷繁鏀粯,鍥犲叕绔嬮啱(y墨)闄㈢殑绲曞ぇ閮ㄥ垎缍�(j墨ng)璨�(f猫i)渚�(l谩i)婧愪簬宸炴斂搴滅殑鎾ユ,寰炶€屽姞閲嶄簡鍦�(gu贸)瀹惰矤(f霉)鎿�(d膩n)銆備簬鏄�,浣滅偤涓€闋�(xi脿ng)閲嶅ぇ鏀归潻,婢冲ぇ鍒╀簽浜�1988骞撮枊(k膩i)濮嬪紩閫�(j矛n)DRGs,鐢ㄤ簬閱�(y墨)闄㈠収(n猫i)閮ㄥ強闄㈤殯闁撹⿻(p铆ng)浼�銆�1991骞�,鎴愮珛婢冲ぇ鍒╀簽鐥呬緥绲勫悎鑷ㄥ簥濮斿摗鏈�(hu矛)(ACCC),绲�(t菕ng)绫岀梾渚嬬祫鍚堟柟妗堢殑鐮旂┒銆�1988-1993骞�,鑱�(li谩n)閭︽斂搴滄姇璩�2930钀�(w脿n)婢冲厓鏀寔鐩搁棞(gu膩n)鐨勭爺绌�,寰炶€屽皫(d菐o)鑷翠簡鍏锋湁婢冲ぇ鍒╀簽鐗硅壊鐨�DRGs鐨勭敘(ch菐n)鐢�銆�1991骞�,鐮斿埗鍑哄叿鏈�527鍊�(g猫)DRGs鐨�AN-DRGv1.0锛�1993骞�,鎺ㄥ嚭鍏锋湁530鍊�(g猫)DRGs鐨�AN-DRGv2.0, 骞跺緸鐣�(d膩ng)骞�7鏈�1鏃ヨ捣,鍏ㄥ湅(gu贸)瀵�(sh铆)琛屾寜DRG鍜�PPS灏�(du矛)閱�(y墨)闄㈤€�(j矛n)琛岃不(f猫i)鐢ㄨ(b菙)鍎�銆�1995骞�,鍙堟帹鍑�AN-DRGv3.0,澧炲姞鍒�667鍊�(g猫)DRGs[5]銆�1999骞�AN-DRG琚洿鐐哄畬鍠勭殑AR - DRG (Australian RefinedDiagnosis Related Groups) 鏇夸唬[7]銆�
        1.4寰峰湅(gu贸)DRG浠樿不(f猫i)妯″紡鍙婂叾鍙栧緱鐨勬垚鏋溿€傚痉鍦�(gu贸)鏀垮簻鍦ㄥ皪(du矛)缇庡湅(gu贸)鍜屾境澶у埄浜炵殑DRGs绯荤当(t菕ng)閫�(j矛n)琛屾繁鍏ョ爺绌跺悗,鏀垮簻浜�2000骞�11鏈�, 鐮旂┒闁�(k膩i)鐧�(f膩)浜嗛仼鍚堝痉鍦�(gu贸)鎳�(y墨ng)鐢ㄧ殑G-DRG绯荤当(t菕ng),骞跺缓绔嬩簡鐢辨硶瀹氶啱(y墨)鐧備繚闅�(xi菐n)鍗�(xi茅)鏈�(hu矛)銆佸晢妤�(y猫)閱�(y墨)鐧備繚闅�(xi菐n)鍗�(xi茅)鏈�(hu矛)鍜屽痉鍦�(gu贸)閱�(y墨)闄㈠崝(xi茅)鏈�(hu矛)鍏卞悓寤虹珛鐨�鈥�閱�(y墨)闄㈣碃浠樼郴绲�(t菕ng)鐮旂┒涓績鈥�(绨�(ji菐n)绋�DRG鐮旂┒涓績)[8]銆備腑蹇冪殑涓昏宸ヤ綔闄ゅ缓绔嬩竴濂楃⒑瀹�DRG鐤剧梾绲勫垾鐨勮(gu墨)鍓囧強鐩搁棞(gu膩n)绶ㄧ⒓鐨勮(gu墨)鍓囧, 涓昏鏄€氶亷(gu貌)鐤剧梾鍜岃不(f猫i)鐢ㄦ暩(sh霉)鎿�(j霉)搴�(k霉)鐨勫缓绔�, 娓�(c猫)绠�DRG鐨勪粯璨�(f猫i)妯�(bi膩o)婧�(zh菙n)銆傚痉鍦�(gu贸)DRG浠樿不(f猫i)鍒跺害纰哄畾鐨勫熀鏈師鍓囨槸: 鍚岀ó鐤剧梾鐨勪粯璨�(f猫i)妯�(bi膩o)婧�(zh菙n)涓€鑷淬€傚叏鍦�(gu贸)浣跨敤绲�(t菕ng)涓€鐨�DRG绶ㄧ⒓锛涘湪閬╃敤鑼冨湇涓�,DRG 绯荤当(t菕ng)骞句箮閬╃敤浜庢墍鏈夌殑鐥呬汉, 鍖呮嫭48 灏忔檪(sh铆)鍏�(n猫i)鍑洪櫌鐨勭梾浜烘垨鑰呴暦(zh菐ng)鏈熶綇闄㈢殑鐥呬汉锛涘湪鐥呯ó鐨勮钃嬩笂, 闄ょ簿绁炵柧鐥呭,DRG绯荤当(t菕ng)骞句箮瑕嗚搵鎵€鏈夌殑鐥呯ó,鐗规畩鏀粯鐨勭梾绋儏闄愪簬琛€閫忕瓑灏戞暩(sh霉)鐥呯ó锛涘湪鐤剧梾鍒嗛鍙婄法纰间笂,閲囩敤鍏�(n猫i)澶栫鍒嗛洟,骞跺厖鍒嗚€冩叜骞剁櫦(f膩)鐧ョ瓑鍥犵礌锛涙牴鎿�(j霉)鍋ュ悍淇濋毆(xi菐n)鏀归潻娉曟纰哄畾鐨勭洰妯�(bi膩o), 鏈€绲傚(sh铆)鐝�(xi脿n)娆�(qu谩n)閲嶇郴鏁�(sh霉)鍏ㄥ绲�(t菕ng)涓€,鍩虹(ch菙)浠樿不(f猫i)妯�(bi膩o)婧�(zh菙n)鍚勫窞绲�(t菕ng)涓€[8]銆傞€欎簺鍩烘湰鍘熷墖灏�(du矛)浜庢垜鍦�(gu贸)瀵�(sh铆)琛�DRG 绯荤当(t菕ng)鏈夊緢澶х殑鍊熼憭鎰忕京銆�
        2DRGs鍦ㄤ腑鍦�(gu贸)鐨勭爺绌跺拰鎳�(y墨ng)鐢ㄧ媭娉�
        2.1DRGs鐞嗚珫鍦ㄦ垜鍦�(gu贸)鐨勭爺绌堕€�(j矛n)灞曟儏娉�:20涓栫磤(j矛)80骞翠唬鏈�,鍦�(gu贸)鍏�(n猫i)瀛�(xu茅)鑰呭凡缍�(j墨ng)闁�(k膩i)濮嬪緸鐞嗚珫涓婃帰绱�DRGs鍦ㄤ腑鍦�(gu贸)閱�(y墨)闄㈢鐞嗕腑鐨勬噳(y墨ng)鐢�銆�1989锝�1993骞�,榛冩収鑻�[9]寮曞叆缇庡湅(gu贸)鐣�(d膩ng)鏅�(sh铆)DRGs鏈€鏂扮増鏈�AP-DRGs鈪�,灏�(du矛)鍖椾含甯�10瀹剁稖鍚堥啱(y墨)闄㈢殑10钀�(w脿n)浠界梾渚嬮€�(j矛n)琛�DRGs鍒嗙祫鐮旂┒, 绲�(ji茅)鏋滆(shu艒)鏄庡皪(du矛)鍑洪櫌鐥呬緥閫�(j矛n)琛�DRGs鍒嗙祫鏄彲琛岀殑銆傚悓鏈�,棣Э[10]鐨勭爺绌堕’绀哄彲浠ラ€氶亷(gu貌)DRGs灏�(du矛)鐥呯ó璨�(f猫i)鐢ㄧ殑鎺у埗瀵�(sh铆)鐝�(xi脿n)閱�(y墨)鐧傝唱(zh矛)閲忕殑鎻愰珮銆�2000骞�,寮靛姏[11]绛変汉寰炶嚚搴婅ê鐧傚垎鍨嬬殑鍩虹(ch菙)涓婃彁鍑�鈥�鍥涘瀷涓夌窔鈥�鐨勭梾渚嬬祫鍚堟柟寮�,鏃ㄥ湪寤虹珛鐥呬緥璩�(zh矛)閲忕鐞嗘寚妯�(bi膩o)楂旂郴銆�2003骞�,钄℃▊(l猫)[12]鎳�(y墨ng)鐢�AID绠楁硶灏�(du矛)浜戝崡鐪佺稖鍚堟€ч啱(y墨)闄�39钀�(w脿n)鐥呬緥閫�(j矛n)琛�DRGs鍒嗙祫鐮旂┒,鏈€鍚庡緱鍑�592鍊�(g猫)鐥呬緥绲勫悎銆備絾涓婅堪鐮旂┒涓昏闆嗕腑鍦�DRGs灏�(du矛)閱�(y墨)闄㈤啱(y墨)鐧傝唱(zh矛)閲忓拰绠＄悊鐨勬噳(y墨ng)鐢ㄦ柟闈�,寰堝皯鏈夌爺绌跺皣DRGs鏂规硶閫�(j矛n)涓€姝ュ紩鐢宠嚦閱�(y墨)鐧備繚闅�(xi菐n)鏀粯鏂瑰紡涓�銆�2004骞�8鏈�,鍦�(gu贸)瀹惰(b菙)璨兼槑纰鸿姹傞€�(j矛n)琛屾寜鐥呯ó浠樿不(f猫i)瑭﹂粸(di菐n), 鐣�(d膩ng)鏅�(sh铆),鍦�(gu贸)瀹惰(w猫i)鐢熼儴杈﹀叕寤充笅鐧�(f膩)浜嗐€婇棞(gu膩n)浜庨枊(k膩i)灞曟寜鐥呯ó鏀惰不(f猫i)绠＄悊瑭﹂粸(di菐n)宸ヤ綔鐨勯€氱煡銆�, 閬告搰浜嗗ぉ娲ャ€侀伡瀵�銆侀粦榫嶆睙銆佸北鏉�銆佹渤鍗椼€侀櫆瑗垮拰闈掓捣绛夊湴鎺㈢储瑭﹂粸(di菐n),鐩殑鍦ㄤ簬:淇冮€�(j矛n)鍥犵梾鏂芥不銆佸悎鐞嗘鏌ュ拰鍚堢悊鐢ㄨ棩, 瑕�(gu墨)鑼冮啱(y墨)鐧傝鐐�, 娓涜紩鎮ｈ€呴啱(y墨)钘ヨ不(f猫i)鐢ㄨ矤(f霉)鎿�(d膩n)[13]銆�

鍦�鈥�浠ヨ棩椁�(y菐ng)閱�(y墨)鈥�鍜�鈥�浠ユ鏌ラ(y菐ng)閱�(y墨)鈥�, 鎻愪緵閬�(gu貌)澶氶啱(y墨)鐧傛湇鍕�(w霉), 浣块啱(y墨)鐧傝不(f猫i)鐢ㄤ笉鏂蜂笂婕茬殑浠婂ぉ,鍠梾绋粯璨�(f猫i)涔熶笉澶辩偤涓€鍊�(g猫)瑙ｆ焙鈥�鐪嬬梾闆�, 鐪嬬梾璨�鈥�鐨勬湁鏁�鏂�銆�
        2.2DRGs鍦ㄦ垜鍦�(gu贸)鐨勬噳(y墨ng)鐢ㄧ従(xi脿n)鐙€:DRGs浣滅偤涓€绋梾渚嬪垎鍨嬬殑鏂规硶,鍙互鐢ㄤ綔灏�(du矛)涓嶅悓閱�(y墨)鐧傛湇鍕�(w霉)姗�(j墨)妲�(g貌u)鎻愪緵鐨勬湇鍕�(w霉)鐨勬晥鐜囧拰璩�(zh矛)閲忛€�(j矛n)琛屾瘮杓�,涔熷彲浠ヤ綔鐐哄仴搴锋湇鍕�(w霉)璩�(g貌u)璨�(m菐i)鐨勬敮浠樹緷鎿�(j霉)銆傚洜?y脿n)妲熷３鍚у舰钁辩含鑺嶈?gu贸)鐗堢殑DRGs,鏁呰┎鏂规硶閭勬矑(m茅i)鏈夋噳(y墨ng)鐢ㄨ嚦鎴戝湅(gu贸)閱�(y墨)闄㈣唱(zh矛)閲忚⿻(p铆ng)鍍�(ji脿)闋�(l菒ng)鍩�,浣嗗湪閱�(y墨)鐧備繚闅�(xi菐n)鏀粯鍒跺害涓�,鐩墠宸叉湁鍩庡競闁�(k膩i)濮嬩簡閮ㄥ垎鐥呯ó鐨�DRGs浠樿不(f猫i)瑭﹂粸(di菐n)銆�2004骞�,涓婃捣甯傞伕鎿囦簡闋嗙敘(ch菐n)绛夊父瑕�(ji脿n)鐨�9鍊�(g猫)鐥呯ó浣滅偤瑭﹂粸(di菐n)(婊啱(y墨)淇濄€�2004銆�108铏�(h脿o)), 2005骞村張澧炲姞浜�6鍊�(g猫)鐥呯ó锛堟滑閱�(y墨)?锛�?/span>2005銆�127铏�(h脿o)), 閫�15鍊�(g猫)鐥呯ó鍧囧爆浜庡绉戠梾姝�, 浠ュ钩鍧囦綇闄㈣不(f猫i)鐢ㄤ綔鐐烘敮浠樻(bi膩o)婧�(zh菙n), 浣嗗(sh铆)鏂芥晥鏋滄湭瑕�(ji脿n)鍫�(b脿o)閬撱€傚叾浠栧煄甯傚浠�鈥�鍠梾绋粯璨�(f猫i)鈥�浣滅偤鐥呯ó浠樿不(f猫i)鐨勬敼闈╁舰寮�, 濡傚寳浜�銆侀櫆瑗�銆佷簯鍗�銆侀噸鎱跺拰榛戦緧姹熺瓑鍦�, 浣嗛€欑ó鈥�鎸夌梾绋粯璨�(f猫i)鈥�鐨勮ō(sh猫)瑷�(j矛)鐞嗗康鍦ㄥ(sh铆)鏂戒腑鏈夋墍璧板舰, 鍦ㄥ緢澶氬湴鍗€(q奴)鏈€绲傛紨鍖栨垚鈥�鍠梾绋檺鍍�(ji脿)鈥�妯″紡:灏囨煇涓€绋柧鐥呮不鐧傛祦绋嬩腑鐨勭敤钘ャ€佹鏌ラ爡(xi脿ng)鐩瓑璨�(f猫i)鐢ㄧ枈鍔犺捣渚�(l谩i),鍒跺畾涓€鍊�(g猫)鏀惰不(f猫i)涓婇檺銆傝秴鏀儴鍒嗙敱閱�(y墨)闄㈣矤(f霉)鎿�(d膩n), 鑻ユ矑(m茅i)鏈夎秴鏀墖鍙渶浜ょ磵瀵�(sh铆)闅涢啱(y墨)鐧傝不(f猫i)鐢�銆傚緸姒傚康涓婁締(l谩i)璎�,鍠梾绋粯璨�(f猫i)鑸�DRGs鍚屽爆浜庢寜鐥呯ó浠樿不(f猫i)鐨勮寖鐤�, 閮芥槸浠ョ柧鐥呰ê鏂风偤鍩虹(ch菙)鐨勬偅鑰呭垎椤炴柟妗�,浣嗗叐鑰呭苟涓嶅畬鍏ㄤ竴鑷淬€�DRGs鍙互鐞嗚В鐐哄叿鏈夊悓涓€涓昏ê鏂蜂笖鑰楃敤璩囨簮鐩镐技鐨勪竴鍊�(g猫)鐥呬緥绲勫悎,鏄叿鏈夌浉浼肩梾鎯呯殑涓€绲勬偅鑰呯殑闆嗗悎,鍏剁祫鍏�(n猫i)鐨勫悓璩�(zh矛)鎬у拰绲勯枔鐨勫樊鐣版€ф槑椤�锛� 鍠梾绋粯璨�(f猫i)鍍呰€冩叜鐤剧梾瑷烘柗, 鐥呯ó闁撹不(f猫i)鐢ㄧ殑绲�(t菕ng)瑷�(j矛)瀛�(xu茅)鐗瑰緛琛ㄧ従(xi脿n)骞朵笉绐佸嚭[14]銆傞櫎鑷�(t谩i)鐏ｅ湴鍗€(q奴)鐗堢殑Tw-DRGs(2007)鍒嗙祫鐐�969闋�(xi脿ng), 鍦�(gu贸)澶栧叾浠栫増鏈竴鑸彧鏈�600鍊�(g猫)宸﹀彸,鑰屽柈鐥呯ó鏈変笂钀�(w脿n)鍊�(g猫),濡傛灉鍐嶈€冩叜鎮ｈ€�銆佹不鐧�銆佸苟鐧�(f膩)鐧ヨ垏鍚堝苟鐧�,鍙兘鏈夊咕钀�(w脿n)銆佸崄骞捐惉(w脿n)鐨勪笉鍚屾儏娉�, 闅ㄨ憲鍠梾绋敮浠樿寖鍦嶇殑鎿�(ku貌)澶�,蹇呯劧鏈�(hu矛)灏�(d菐o)鑷撮亷(gu貌)楂樼殑绠＄悊璨�(f猫i)鐢�銆傚洜姝�,寰炲柈鐥呯ó鍚�DRGs閬�(gu貌)娓℃噳(y墨ng)鐣�(d膩ng)鏄(sh铆)鏂芥寜鐥呯ó浠樿不(f猫i)鐨勫繀鐒惰定鍕�(sh矛)銆�
        2.3DRGs鍦ㄦ垜鍦�(gu贸)闈㈣嚚鐨勬寫鎴�(zh脿n):DRGs鏄暥(d膩ng)鍓嶅湅(gu贸)闅涗笂鍏獚(r猫n)鐨勬瘮杓冨厛閫�(j矛n)鍜岀瀛�(xu茅)鐨勪粯璨�(f猫i)鏂瑰紡,浣嗗彈鎴戝湅(gu贸)琛�(w猫i)鐢熶簨妤�(y猫)鐧�(f膩)灞曟按骞崇瓑鏂归潰鐨勫奖闊�, 鎴戝湅(gu贸)瀵�(sh铆)琛屽柈鐥呯ó鍚�DRGs鐨勯亷(gu貌)娓℃渻(hu矛)閬囧埌寰堝鍥伴洠,鍠梾绋敹璨�(f猫i)浣块啱(y墨)鍕�(w霉)浜哄摗鏃㈣淇濊瓑閱�(y墨)鐧傝唱(zh矛)閲忥紝鍙堣鑰冩叜璨�(f猫i)鐢ㄥ晱(w猫n)椤�锛屽鍔犱簡閱�(y墨)鐧傞ⅷ(f膿ng)闅�(xi菐n)锛岃嚧浣块啱(y墨)闄笉鏁㈣部(m脿o)鐒惰浜�[15]銆傜敱浜庣柧鐥呯殑寰�(f霉)闆滄€с€佷笉鍙爯(y霉)娓�(c猫)鎬у拰鎴愭湰璨�(f猫i)鐢ㄧ殑涓嶅彲鎺у埗锛屼娇寰楃梾绋殑鎸戦伕闆ｅ害杓冨ぇ[16]銆傚叾娆�锛屽児(ji脿)鏍肩殑娓�(c猫)绠楀伐浣滄瘮杓冨京(f霉)闆�銆傜敱浜庣梾绋京(f霉)闆滃璁�锛屽嵆浣垮悓涓€鐤剧梾涔熸渻(hu矛)鍥犳不鐧傛柟鐥呮儏涓嶅悓鑰岄€犳垚鎴愭湰鐨勫緢澶у樊鐣�[17]銆傚洜姝�,闇€瑕侀潏娲绘噳(y墨ng)灏�(du矛)鍙兘鍑虹従(xi脿n)鐨勫叿楂斿晱(w猫n)椤�銆�(1)鍋ュ叏鐨勪俊鎭郴绲�(t菕ng)銆�DRGs瑕佹眰閱�(y墨)闄㈠繀闋堟湁瀹屽杽鐨勪俊鎭寲绯荤当(t菕ng),浣跨鐞嗚€呮帉鎻″悇椤炵柧鐥呯殑鑷ㄥ簥瑷虹檪鐝�(xi脿n)鐙€,鍙婃檪(sh铆)灏�(du矛)涓€浜涚柧鐥呰ê鏂峰垎椤為€�(j矛n)琛岃(di脿o)鏁�,浣嗘槸,鎴戝湅(gu贸)鐩墠鐨勫湅(gu贸)鎯呮槸寰堝閱�(y墨)鐧傛(j墨)妲�(g貌u)鐨勪俊鎭郴绲�(t菕ng)寤鸿ō(sh猫)閭勪笉澶犲仴鍏�,鑰屼笖,鍦ㄧ煭鏅�(sh铆)闁撳収(n猫i)鍙栧緱閲嶅ぇ绐佺牬涔熶笉鍒囧(sh铆)闅�銆�(2)鎴戝湅(gu贸)鍏�(n猫i)鍦伴啱(y墨)鐧傝不(f猫i)鐢ㄧ殑鎯呮硜鑸囪タ鏂�(缇庡湅(gu贸)銆佸痉鍦�(gu贸)銆佹境澶у埄浜�), 鐢氳嚦浜炴床(鏃ユ湰銆佹柊鍔犲潯鍙婃垜鍦�(gu贸)鐨勮嚭(t谩i)鐏ｅ拰棣欐腐)鍧囨湁寰堝ぇ鐨勪笉鍚�銆備富瑕佹槸浜哄姏鎴愭湰鍦ㄧ梾浜鸿不(f猫i)鐢ㄤ腑鎵€鍗犵殑姣旈噸鏄庨’鍋忎綆, 钘ュ搧鍜岄啱(y墨)鐢ㄦ潗鏂欐墍鍗犳瘮閲嶉亷(gu貌)楂�[18], 鍥犳, 鐥呬汉璨�(f猫i)鐢ㄦ墍琛ㄧ従(xi脿n)鍑轰締(l谩i)鐨勭当(t菕ng)瑷�(j矛)瑕�(gu墨)寰嬪緢鍙兘鑸囨捣澶栫殑鎯呮硜鏈夐’钁楃殑宸暟銆傚皪(du矛)鏌愪簺鐤剧梾,鎴戝€戝彲鑳戒笉寰椾笉鎻愬嚭鎴戝湅(gu贸)绱�(x矛)鍖栫殑DRGs鍒嗙祫鐨勭壒娈婃柟妗�(Chinese RefineDRGs),閫欏氨瑕佹眰瑭崇窗(x矛)浜嗚В鐥呬汉鐨勬不鐧傞亷(gu貌)绋�,璨�(f猫i)鐢ㄦ垚鏈垎鏋愬拰鏇寸偤绱�(x矛)鑷寸殑鍘熷鏁�(sh霉)鎿�(j霉)[19]銆�(3)閱�(y墨)淇濊钃嬮潰銆傜編鍦�(gu贸)涔嬫墍浠ヨ兘寰堝ソ鍦版帹琛�DRGs闋�(y霉)浠樺埗搴�, 鑸囩編鍦�(gu贸)閱�(y墨)淇濊钃嬮潰杓冨ぇ閫欎竴鍦�(gu贸)鎯呭瘑涓嶅彲鍒�銆�DRGs涓嶆槸鏍规摎(j霉)閱�(y墨)闄㈢殑鎶曞叆,鑰屾槸鎸夌収閱�(y墨)闄㈡敹娌荤殑鐥呬緥鍙婂叾瑷烘柗鍒跺畾鐩告噳(y墨ng)鐨勮(b菙)鍎熸(bi膩o)婧�(zh菙n),閫氶亷(gu貌)閱�(y墨)鐧備繚闅�(xi菐n)灏�(du矛)閱�(y墨)闄㈢洿鎺ヨ(b菙)鍎�,浣挎斂搴滃皪(du矛)閱�(y墨)鐧傝不(f猫i)鐢ㄧ殑鎺у埗鏇寸偤鐩存帴鍜屾湁鏁堛€傝€岀洰鍓�,鎴戝湅(gu贸)閱�(y墨)鐧備繚闅�(xi菐n)瑕嗚搵鐨勪汉缇ゅ儏鍗犲叏鍦�(gu贸)绺�?c猫)涓濊瘶?/span>10%宸﹀彸,澶ч噺鐨勮嚜璨�(f猫i)鐥呬汉鍜岃嚜璨�(f猫i)闋�(xi脿ng)鐩浣曠磵鍏ュ埌DRGs鐨勮碃浠橀珨绯讳篃鏄垜鍦�(gu贸)閱�(y墨)鐧備粯璨�(f猫i)鍒跺害鏀归潻蹇呴爤闈㈠皪(du矛)鐨勭壒娈婂晱(w猫n)椤�[20]銆�(4)绲�(t菕ng)涓€鐨勭鐞嗙爺绌朵腑蹇冦€傚鍓嶆墍杩�, 寰峰湅(gu贸)DRG浠樿不(f猫i)鍒跺害鐨勬帹閫�(j矛n)寰楃泭浜庢墍寤虹珛鐨�DRG鐮旂┒涓績, 璨�(f霉)璨�(z茅)寤虹珛涓€濂楃⒑瀹�DRG鐤剧梾绲勫垾鐨勮(gu墨)鍓囧強鐩搁棞(gu膩n)绶ㄧ⒓鐨勮(gu墨)鍓�, 寤虹珛绲�(t菕ng)涓€鐨勭柧鐥呭拰璨�(f猫i)鐢ㄦ暩(sh霉)鎿�(j霉)搴�(k霉), 娓�(c猫)绠�DRG鐨勪粯璨�(f猫i)妯�(bi膩o)婧�(zh菙n),閫欑偤浠栧€�?c猫)璋岀彇?gu贸)鑼冨湇鍏�(n猫i)DRG浠樿不(f猫i)鍒跺害鐨勭当(t菕ng)涓€瀵�(sh铆)鏂藉瀹氫簡鍩虹(ch菙), 鍙栧緱浜嗕竴瀹氱殑鎴愭晥銆傝€屾垜鍦�(gu贸)浜哄彛鐪惧,鍦板崁(q奴)宸暟杓冨ぇ,鐩墠,鐪佷竴绱�(j铆)鐨勭当(t菕ng)涓€閮藉緢闆ｉ仈(d谩)鍒�,鍏ㄥ湅(gu贸)鑼冨湇鍏�(n猫i)鐨勭当(t菕ng)涓€鏇存槸涓€闋�(xi脿ng)鑹卞法鐨勫伐绋嬨€�
        缍滀笂鎵€杩�, 鐝�(xi脿n)闅庢鎴戝湅(gu贸)閱�(y墨)鐧備繚闅�(xi菐n)瀵�(sh铆)鏂藉叏鐥呯ó鐨�DRGs鏀粯鍒跺害鐨勬浠堕倓涓嶅鎴愮啛, 浣嗘寜鐥呯ó浠樿不(f猫i)鏇夸唬鍌崇当(t菕ng)鐨勬寜闋�(xi脿ng)鐩粯璨�(f猫i)宸叉垚鐐洪啱(y墨)鐧備繚闅�(xi菐n)鏀粯鍒跺害鐧�(f膩)灞曠殑蹇呯劧瓒ㄥ嫝(sh矛)銆傚皪(du矛)浜庨啱(y墨)闄俊鎭郴绲�(t菕ng)姣旇純鍋ュ叏鐨勫煄甯�,鍙互鍢楄│閫�(j矛n)琛�DRGs鍒嗙祫鐮旂┒,灏�(du矛)鍏朵腑鐨勫父瑕�(ji脿n)鐥呯ó閫�(j矛n)琛�DRGs鏀粯瑭﹂粸(di菐n),鍦ㄧ⿳绱鐞嗙稉(j墨ng)椹�(y脿n)鐨勫悓鏅�(sh铆)閫愭鎿�(ku貌)澶�DRGs瀵�(sh铆)鏂借寖鍦�,鏈€绲傚舰鎴愪腑鍦�(gu贸)鐗堢殑DRGs鏀粯鍒跺害銆�
鍙冭€冩枃鐛�(xi脿n)
[1]閬�(d谩)婕㈢幉.鐩搁棞(gu膩n)瑷烘柗鍒嗙祫锛�DRGs锛夌啊(ji菐n)浠�[J].涓湅(gu贸)鐥呮锛�2006锛�7锛�8-11锛夛細2
[2]閮瘜濞�,浠昏嫆. DRGs鍦ㄧ編鍦�(gu贸)鐨勭櫦(f膩)灞曞強鍦ㄦ垜鍦�(gu贸)鐨勬噳(y墨ng)鐢ㄥ皪(du矛)绛�[J].涓湅(gu贸)閱�(y墨)闄㈢鐞�,2006,26 (2):32-35
[3]钀�(w脿n)宕囪彲,钄℃▊(l猫),瑷卞偝蹇�,绛�.鐤剧梾瑷烘柗鐩搁棞(gu膩n)绲�DRGs鐮旂┒鐨勭従(xi脿n)鐙€銆佸晱(w猫n)椤屽強灏�(du矛)绛�[J].涓湅(gu贸)閱�(y墨)闄㈢当(t菕ng)瑷�(j矛),2001,6(2):112-114
[4]娲湅(gu贸)鐕�,濮氳┊.鎸夌梾绋爯(y霉)浠樺埗鐨勫彲琛屾€ф帰瑷�[J].涓湅(gu贸)閱�(y墨)闄㈢鐞�,2006,26(1):14-16
[5]閮瘜濞�,浠昏嫆.DRGs鍦ㄧ編鍦�(gu贸)鐨勭櫦(f膩)灞曞強鍦ㄦ垜鍦�(gu贸)鐨勬噳(y墨ng)鐢ㄥ皪(du矛)绛�[J].涓湅(gu贸)閱�(y墨)闄㈢鐞�,2006,26(2): 32- 35
[6]钀�(w脿n)宕囪彲,钄℃▊(l猫),瑷卞偝蹇�,绛�.鐤剧梾瑷烘柗鐩搁棞(gu膩n)绲�DRGs鐮旂┒鐨勭従(xi脿n)鐙€銆佸晱(w猫n)椤屽強灏�(du矛)绛�[J].涓湅(gu贸)閱�(y墨)闄㈢当(t菕ng)瑷�(j矛), 2001,8(2):112-115
[7]鍛ㄥ畤,閯ü(sh霉)蹇�,瀛湅(gu贸)妤�.寰峰湅(gu贸)DRG浠樿不(f猫i)鍒跺害鐨勫€熼憭[J].涓湅(gu贸)琛�(w猫i)鐢熻硣婧�, 2004,7(4): 186-187
[8]鍛ㄥ畤,閯ü(sh霉)蹇�,瀛湅(gu贸)妤�.寰峰湅(gu贸)鐨�DRG浠樿不(f猫i)鍒跺害[J].涓湅(gu贸)琛�(w猫i)鐢熻硣婧�,2004,7(3):139-141
[9]榛冩収鑻�.鐤剧梾瑷烘柗鐩搁棞(gu膩n)鍒嗛娉曞湪鍖椾含鍦板崁(q奴)閱�(y墨)闄㈢鐞嗕腑鐨勫彲琛屾€х爺绌�[J].涓彲閱�(y墨)闄㈢鐞嗛洔蹇�, 1994,10(3):131
[10]棣Э.鐥呯óDRGs璨�(f猫i)鐢ㄨ垏璩�(zh矛)閲忛洐鍚戞娓�(c猫)瑭﹂(y脿n)鐮旂┒[J].涓湅(gu贸)閱�(y墨)闄㈢鐞�,1994,14(9):14
[11]寮靛姏,钁ｈ粛,棣仴.鐥呬緥绲勫悎鏂规硶鐨勭爺绌�[J].瑙ｆ斁杌嶉啱(y墨)闄㈢鐞嗛洔蹇�,2000,7(2):108-111
[12]钄℃▊(l猫).浜戝崡鐪佺稖鍚堟€ч啱(y墨)闄綇闄㈡偅鑰�DRGs绲勫悎鏂瑰紡鐮旂┒[D].鏄嗘槑:鏄嗘槑閱�(y墨)瀛�(xu茅)闄�,2003
[13]閲戣櫣.鎸夌梾绋粯璨�(f猫i):甯傚牬(ch菐ng)鑸囨斂搴滆兘鍚�鈥�鎺ヨ粚鈥漑J].閱�(y墨)闄㈢鐞嗚珫澹�,2006(11):28-31
[14]棣炒,鍔夐亱(y霉n)鍦�(gu贸),闄冲·鍚�.鏂板瀷杈�(n贸ng)鏉戝悎浣滈啱(y墨)鐧備腑鍠梾绋畾椤嶄粯璨�(f猫i)鐨勭梾绋伕鎿�[J].涓湅(gu贸)琛�(w猫i)鐢熺稉(j墨ng)婵�(j矛),2007,26(7):31
[15]鐜嬮嫆.灏�(du矛)閱�(y墨)鐧備繚闅�(xi菐n)鏀粯鏂瑰紡鏀归潻鍜屽柈鐥呯ó鎴愭湰鏍哥畻鐨勬帰瑷�[J].涓湅(gu贸)閱�(y墨)钘ュ皫(d菐o)鍒�,2006,8(3): 220-222
[16]妤婂嘲锛岀帇鍌宠硛锛屽緪鐡婅姳锛岀瓑.閱�(y墨)闄�?ji菐n)灏俱€婲闄愬児(ji脿)鏀惰不(f猫i)鐨�SWOT鍒嗘瀽鑸囨€濊€�[J].閱�(y墨)瀛�(xu茅)鑸囩ぞ鏈�(hu矛)锛�2007锛�20锛�10锛夛細42-43
[17]浠绘剾(脿i)鐜�锛屽皻鍩逛腑锛屽懆槌虫锛岀瓑.鍠梾绋檺鍍�(ji脿)鏀惰不(f猫i)鑸囪嚚搴婅矾寰戠鐞�[J].娌冲寳鍖楁柟瀛�(xu茅)闄㈠(xu茅)鍫�(b脿o)锛堥啱(y墨)瀛�(xu茅)鐗堬級锛�2006锛�23锛�5锛夛細65-66
[18]鏈卞瓟鏉�.灏�(du矛)閱�(y墨)闄�?ji菐n)灏俱€婲闄愬児(ji脿)鏀惰不(f猫i)鐨勫垎鏋愯垏鎬濊€�[J].涓湅(gu贸)閱�(y墨)钘ュ皫(d菐o)鍫�(b脿o)锛�2007锛�4锛�22锛夛細104-105
[19]鏉庡寘缇�,鑿.DRGs鏄瀛�(xu茅)瑙ｆ焙鈥�鐪嬬梾璨�鈥�鍟�(w猫n)椤岀殑鏈夋晥閫斿緫[J].涓湅(gu贸)閱�(y墨)闄㈢鐞�, 2006, 26(3): 19-22
[20]鏈辨枌娴�.鐮旂┒鍜屽(sh铆)鏂�DRGs鏅�(sh铆)鎳�(y墨ng)鑰冩叜鐨勮嫢骞插晱(w猫n)椤�[J].涓彲閱�(y墨)闄㈢鐞嗭紝2006锛�7锛�456-549