现代医院2025，Vol.25Issue(7)：1056-1060,5.DOI:10.3969/j.issn.1671-332X.2025.07.020
DRG/DIP视角下日间手术医保管理实践
Practice of medical insurance management for ambulatory surgery from the perspective of DRG/DIP
摘要
Abstract
Objective With the comprehensive implementation of Diagnosis-Related Groups(DRG)and Diagnosis-In-tervention Packet(DIP)payment reforms,ambulatory surgery has been widely adopted in clinical practice due to its efficiency and cost-effectiveness.However,medical insurance compliance issues have become increasingly prominent during management processes.Standardizing ambulatory surgery management and ensuring the security of medical insurance funds have grown in im-portance.Methods Based on the current status of ambulatory surgery medical insurance policies in Tianjin,this study analyzes common compliance issues under DRG/DIP payment systems,explores their causes,and proposes targeted management strate-gies.Results Tianjin currently has 786 ambulatory surgery procedures,with orthopedics being the most common specialty,fol-lowed by ophthalmology,urology,and general surgery.From 2020 to 2024,the sample hospital completed 12,705 ambulatory surgery cases,with a significant increase in 2024.In 2020,the most frequent procedure was circumcision,while in 2024,it was colonoscopic polypectomy.Under DRG/DIP payment systems,common medical insurance compliance issues include upeoding,split hospitalization,excessive treatment,cost shifting,and undertreatment.Conclusion Healthcare and medical insurance sys-tems should collaborate to implement targeted management strategies.These include strengthening hospital medical record and coding management,improving medical quality control,refining medical insurance supervision mechanisms and payment stand-ards,and establishing a multi-stakeholder collaborative oversight system.These measures aim to standardize ambulatory surgery management,safeguard medical insurance funds,and promote the healthy development of the healthcare industry.关键词
DRG/DIP付费/日间手术/医保违规/管理策略Key words
DRG/DIP payment/Ambulatory surgery/Medical insurance compliance/Management strategy分类
医药卫生引用本文复制引用
张磊,李会明,荣洁..DRG/DIP视角下日间手术医保管理实践[J].现代医院,2025,25(7):1056-1060,5.基金项目
天津市医院协会医院管理研究项目(2022zc31) （2022zc31）
天津市人民医院院级基金项目(2024YJGL039) （2024YJGL039）
