Research On DRG Payment Reform Of Medical Security

The medical insurance system is one of the most important social insurances in the country.It has played an important role in reducing the burden of medical treatment for the people and promoting social and economic development.Although the medical insurance industry in my country has only developed for more than 20 years,it has built a system covering the whole people.,The medical security business with a relatively complete system,especially after the 18 th National Congress of the Communist Party of China,my country has continuously implemented reforms in the medical field,and the medical security business has developed rapidly.However,the rapid growth of medical expenses is becoming a common problem in various regions.According to the data of the National Bureau of Statistics,since 2021,the growth rate of medical and health expenses in my country has exceeded the growth rate of GDP,and the total medical and health expenses accounted for GDP.The proportion is increasing year by year,which shows that our country is facing a serious problem of medical expenses.In response to the problem of "expensive and difficult to see a doctor" in the mouth of the masses,my country is gradually implementing and deepening reforms in the field of medical security,and has successively introduced reform measures such as hierarchical diagnosis and treatment,zero markup on drugs in public hospitals,and payment according to disease diagnosis-related groups.The purpose of the medical insurance payment reform is to reasonably control medical expenses and ensure the balance of income and expenditure of the medical insurance fund while meeting the medical needs of the masses.Diagnosis-related group(DRG)payment is one of the relatively scientific and reasonable medical insurance payment methods in the world.At the same time,DRG payment reform is also one of the important tasks in deepening the reform of the medical security system.Medical reform has been an important task since the establishment of the Medical Insurance Bureau.one.At present,domestic and foreign studies all believe that DRG payment reform can effectively control the unreasonable growth of medical fund expenditure,and is also conducive to improving service quality of medical institutions,reducing medical expenses of patients,promoting the implementation of hierarchical diagnosis and treatment policies,and improving the utilization rate of regional medical resources.To achieve a win-win situation for all parties involved in medical insurance and patients.In recent years,some regions in China have taken the lead in carrying out DRG payment reforms.However,due to factors such as different local medical conditions and numerous grouping versions,there are also large differences in the operating results of various regions.City S,as a DRG pilot city in Province J,has initially realized the formal payment of 6 medical institutions through more than two years of exploration and operation.Taking S City as an example to study DRG payment reform can deepen the understanding of DRG payment reform.Through analysis The problems in the operation of DRG payment in City S provide work experience for other regions to carry out DRG payment reform,and are also conducive to the overall promotion and deepening of medical reform in the whole province.At present,there are still not many cities that have fully implemented DRG payment reform.The impact of DRG payment reform on medical reform has become the focus of common attention in academia and society.From the perspective of the medical insurance department,this article sorts out the current DRG payment system reform in S city The way of work,analyze the problems in the work,think about the potential risks that may exist,put forward optimization suggestions for DRG reform,and look forward to the expected effect after the completion of DRG reform.The first part briefly introduces DRG payment.Mainly explain the background and significance of DRG paid research,the current research results at home and abroad,as well as the research methods and research innovations of this paper.The second part introduces related concepts,studies the scope and application scenarios of DRG payment reform,and introduces the application of hospital performance management theory,stakeholder theory,and principal-agent theory in DRG payment reform.The third part studies the specific practices of city S to promote DRG payment reform.Firstly,the basic situation of S city and the significance of the reform are analyzed,and then the analysis and research are carried out from the aspects of electronic information preparation,organizational structure and system construction,pilot medical institutions,payment parameter design concept,payment system supervision and assessment,and payment operation.The fourth part studies and promotes the problems found in the pilot work of DRG reform and discusses the causes of the problems.The fifth part aims at the possible risks in the DRG payment reform,and puts forward optimization suggestions for reference by other cities in promoting the DRG payment reform.This study uses literature research,data statistics,questionnaire survey and other research methods to summarize the DRG payment reform work in S city,which has certain reference value for the construction and improvement of DRG payment reform in other regions,and finally realizes the overall reduction of medical expenses Expected results of growth.