Discussion On The Implementation Path Of DRG Payment Reform In Public Hospitals

For a long time,public hospitals in our country are facing a serious shortage of financial investment and it is difficult to adjust the price of healthcare services and technical labor to a reasonable price level.Public hospitals heavily rely on medicines and medical consumables for their compensation.Fee for service paymentwas used as a"source" for hospitals to induce patients to over-consume medical resources.The payment sy stem reform is considered as one of the effective method to solve this problem.In recent years,the prepaid system reform from post-payment to case payment has been gradually advanced.In June 2017,the National Health and Family Planning Commission launched a C-DRG payment pilot reform in selected areas in China.However,compared with the current fee for service payment,the concept of DRG payment has undergone great changes and the reform has a certain degree of complexity,which poses greater challenges to public hospitals.To help public hospitals to adapt changes,avoid detours,and make a smooth transition,this topic explores in depth the feasible paths for DRG payments in public hospitals.The research idea is based on the whole process of patient settlement from hospital admission to discharge in public hospitals in China.It analyzes the key steps of DRG payment in public hospitals,refines the key elements,explores the implementation paths as the core,and conducts spot test.The aim is to provide reference for public hospitals in China during the initial period of reform,and also provide evidence for promoting the DRG payment system reform in the public hospitals.The research of this topic includes three parts:the first part is to establish the theoretical study of the implementation path,the second part is to analyze the process of establishing the implementation path,and the third part is the empirical study of the implementation path.The research methods include literature analysis,questionnaire survey,Delphi method and statistical analysis methods in spot test.The main result:1.Designing a public hospital payment system implementation path.Researching the waterfall theory in the system's R&D lifecycle theory.Refer to its theoretical ideas and designing research ideas from planning,design,generation,testing,and implementation.Follow the interlocking designin principle.2.By analyzing of the patient's entire process from hospital admission to hospital discharge,it analyzes the important steps involved in achieving the necessary transformation and adjustment of DRG payment,including expense estimation,clinician application,other diagnosis and treatment information collection,cost settlement and medical insurance.Payment,medical record management,statistical reporting,information system support,etc.,from the analysis and extraction of standard establishment,flow transformation,cost forecasting(cost),quality control(quality),and informationization(informatization)5 key elements.On the basis of comparative analysis of a large number of documents,the key elements and their specific contents are weighted using the hierarchical expert scoring method.The index weight of the first-level elements of the index system is standard 0.2689,process 0.2007,quality control 0.2222,information 0.2170,cost 0.0912.3.Taking the H hospital in A city,one of the C-DRG pilot cities,as a case hospital for on-site testing,based on the C-DRG collection and payment reform practice in H hospital from August 2017 to February 2018,based on the revision and verification of S-F-Q-I-C implementation path The specific content of the results shows that H hospital has successfully completed various tasks according to the path,smoothly transitioning from project-to-project payment to DRG-based payment,and the operation is basically stable.The lack of effectiveness is mainly reflected in the four related elements of standards,processes,quality control,and informatization,which have verified the feasibility and scientificity of the implementation path to some extent.Conclusion:The implementation path of the five elements of S-F-Q-I-C is the implementation path available for public hospitals in the early stages of the reform of China's C-DRG payment system,which is feasible and scientific.Standards,processes,quality control,informatization,and cost estimation are the five most important factors.