中国全科医学2025，Vol.28Issue(19)：2441-2448,8.DOI:10.12114/j.issn.1007-9572.2024.0535
紧密型县域医共体下人头总额预付与DRG付费协同机制研究:基于整体性治理视角
The Synergistic Mechanism of Capitation Prepayment and DRG Payment in Compact County-level Medical Consortium:from the Perspective of Holistic Governance
摘要
Abstract
Background All regions in China are actively promoting the reform of the prepaid payment method for the total amount of medical insurance in the context of the integrated medical community.However,the integration of DRG/DIP payment and the total amount payment policy within the integrated medical community is still in the exploratory stage.Although there have been studies on the cost control effect and cost control mechanism of the composite medical insurance payment method,there is still room for expansion.Objective To analyze the synergistic mechanism and effects of capitation prepayment and DRG payment in the compact county-level medical consortium.Methods In July 2023,a field survey was conducted in Yindu District.The convenience sampling method was used to select key informants within the integrated medical community for semi-structured interviews(n=28).The interview outline covered medical insurance payment reform policies and measures,incentive mechanisms,work perceptions and optimization suggestions,etc.Based on the holistic governance theory,the thematic framework analysis method was used to analyze the interview data to build a coordination mechanism framework for the prepaid payment for the total number of people and the DRG payment in the integrated medical community in Yindu District.Meanwhile,policy documents closely related to the construction of the integrated medical community and medical insurance reform in Yindu District published from January 2017 to July 2024 were retrieved(n=18)to supplement relevant policy background information.Results A thematic framework with 4 analytical themes,namely policy behavior,supervision behavior,service behavior and incentive mechanism,covering 12 sub-themes was formed.The medical insurance payment reform plays a key guiding role in the governance framework of the integrated medical community.There was a sequential compliance relationship between the prepaid payment for the total number of people and the DRG payment.The coordination mechanism between the prepaid payment for the total number of people and the DRG payment within the integrated medical community was achieved through mutual supplementation,improvement of policy behavior,supervision behavior and the incentive mechanism for service behavior.Both were indispensable for realizing resource integration and the goal of"health-centered"in the integrated medical community.Conclusion In a compact medical community,capitation prepayment and DRG payment systems,by establishing integration mechanisms and incentive structures,can synergize policy efforts,influence policy implementation behaviors,oversight activities,and the service delivery practices of healthcare institutions at all levels.Together,these factors contribute to the achievement of a"health-centered"goal.关键词
紧密型县域医共体/人头总额预付/DRG付费/整体性治理/医保支付方式Key words
Compact county-level medical consortium/Capitation prepayment/DRG payment/Holistic governance/Payment method of medical insurance分类
预防医学引用本文复制引用
张梓洵,尹刚,边颖,陶红兵..紧密型县域医共体下人头总额预付与DRG付费协同机制研究:基于整体性治理视角[J].中国全科医学,2025,28(19):2441-2448,8.基金项目
国家自然科学基金资助项目(72074093) （72074093）
