DRGs is recognized as one of the more advanced payment methods in the world today. The guiding ideology of DRGs is to standardize the utilization of medical resources by formulating a unified standard of fixed payment for disease diagnosis and classification. It is helpful to encourage hospitals to strengthen medical quality management, force hospitals to actively reduce costs, shorten hospitalization days, and reduce induced medical expenses to make profits, which is conducive to cost control.
In the process of implementation, many countries have found its further advantages: it effectively reduces the management difficulty and cost of medical insurance institutions; Conducive to the macro prediction and control of medical expenses; It provides a scientific and comparable classification method for the evaluation of medical quality.
The basic starting point for DRGs to be used in the payment system of medical expenses is that the payer of medical insurance does not pay according to the actual cost of patients' hospitalization (that is, according to the service items), but according to the disease-related population divided by patients according to conditions such as diseases, severity and treatment methods. There are different DRG codes for different diseases, different patients and different treatment methods.
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As a management method and means to strengthen hospital management and improve medical quality, the effectiveness of DRGs is constantly emerging, bringing people achievements:
1. For the medical insurance department, the biggest benefit of implementing DRGs is the safe use of medical insurance funds. While controlling the cost of medical insurance, we should guide medical institutions to standardize medical behavior by clarifying the payment standard and medical quality of each patient group.
2. For medical institutions, in the face of new payment methods, we can adopt a more scientific clinical path, standardize medical business processes, improve operational efficiency, and maximize medical resources.
3. For patients, while receiving reasonable and efficient treatment, personal expenses have also been effectively controlled.
From the perspective of practical exploration, DRGs is a win-win situation for medical insurance, medical institutions and patients.
Baidu encyclopedia -DRGs