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DRG是在建立一种确定医院各种病历类型的方法,对疾病进行分类分项统计,从而计算出医院在某项疾病诊断治疗方面所需要的平均费用。由此形成一套疾病分类系统,以此系统作为医疗费用基础,由保险公司支付补偿给医院,医院的收入与实际成本无关,与每个病例以及诊断有关。这种制度的出现,真正改变了医疗保险作为第三方的被动局面。通过制定预付标准控制支出,并通过预算强迫、约束提供者承担经济风险,以此达到规范自身的医院管理行为的目的。
DRG is to establish a method to determine the types of medical records in hospitals, and to perform statistical classification of diseases, so as to calculate the average cost of the hospital in the diagnosis and treatment of a certain disease. A disease classification system was thus formed. As a basis for medical expenses, the insurance company paid the compensation to the hospital. The income of the hospital has nothing to do with the actual cost and is related to each case and diagnosis. The emergence of such a system has truly changed the passive situation of medical insurance as a third party. Through the establishment of prepayment standards to control expenditures, and through budgetary forcing and binding providers to bear economic risks, in order to achieve the purpose of regulating their own hospital management behavior.