診斷關聯群附加支付的發展與應用

李卓倫; 洪錦墩; 陳文意; 蔡梓鑫; 紀駿輝

doi:10.6288/TJPH2013-32-03-01

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P205 - 219

医药卫生 > 预防保健与卫生学
医药卫生 > 社会医学

DOI： 10.6288/TJPH

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诊断关联群附加支付的发展与应用

The Development and Application of Add-On Payments in a DRG System

李卓伦(Jwo-Leun Lee) ；洪锦墩(Chin-Tun Hung) ；陈文意(Wen-Yi Chen) ；蔡梓鑫(Tzu-Hsin Tsai) ；纪骏辉(Chun-Huei Chi)

台湾公共卫生杂志； 32 卷 3 期 (2013 / 06 / 15) ， P205 - 219

繁体中文 DOI： 10.6288/TJPH2013-32-03-01

诊断关联群；附加支付；新兴医疗科技；健康保险； DRGs ； add-on payment ； new medical technology ； health insurance

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摘要 │ 参考文献 (31) │ 被引用文献 (2) │ 国际计量

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New medical technologies have often been applied to inpatient care; however, when a new medical technology becomes available in the market but is not yet covered by national health insurance, such a technology is excluded from the Diagnosis-Related Group (DRG) list. Consequently, hospitals may be reluctant to use it. Ideally, once a new medical technology is approved by the government, it should undergo a health technology assessment (HTA) to ascertain its applicability, effectiveness, and cost-effectiveness before it is covered by a national health system. At present, however, the lack of HTAs makes the relative advantage of a new medical technology unclear. The adoption and use of a new technology in a fee-for-service payment system usually leads to increased medical expenditure. This is where the introduction of DRG add-ons plays an important role in regulating the rates of adoption of technology and rising expenditures. The major challenge in dealing with a new medical technology is how to design a payment system that will achieve the goal of controlling expenditure while providing adequate incentives for technological improvement. The purpose of this article is to compare how several industrialized nations designed their DRG add-on payment incentives in order to regulate the adoption of new medical technologies by their national health care systems, and to provide policy implications for Taiwan. We summarized the DRG add-on payment systems implemented in the United States (U.S.), Germany, France, Italy, and the United Kingdom (U.K.). Their systems share several common features in that they are consistent with the existing payment system, emphasize professional autonomy, use primary diagnostic codes as the foundation, provide formulas for negotiation, and are based on technology assessment (except Italy). There are unique features in some countries, such as an emphasis on cost control (Germany, France and Italy), restrictions on who can apply (Germany and France), setting up review committees (Germany and France), a cost-based foundation for medical technology (U.S., Germany and U.K.), and an emphasis on transparency (U.S., Germany and U.K.). For Taiwan, the lessons we learned from these countries include the importance of DRG add-on payments in providing consistency in the payment system, control of long-term health care costs and control of household out-of-pocket payments for health care. In order for DRG add-ons to achieve policy goals, Taiwan needs to establish systems for medical technology assessment and standardized medical cost accounting.

参考文献 ( 31 ) 〈TOP〉

Martin TD. Relating diagnosis-related groups: what Germany and the United States can learn from each other about acute-care payment systems. Available at: http://works.bepress.com/timothy_martin/6/. Accessed July 4, 2012
MEDIClever. A shortcut to medical device reimbursement in France. Available at: http://www.mediclever.com. Accessed July 4, 2012
The Medicare, Medicaid, and State Children's Health Insurance Program (SCHIP). Benefits Improvement and Protection Act of 2000 (BIPA), Section 533(b), Final rule 66 FR 46902, 2001
KHEntgG. Krankenhausentgeltgesetz 2010. Hospital Reimbursement Act, Dec. 22, 2010 Reichsgesetzblatt I [RGBl. I] as amended, at § 6, 2309 (Ger.), 2010.
Ashwell S. 2009-10 Pass Through Payments. Attachment 3. Application for a drug or technology development to be reviewed against criteria that define items that may be added to EoE list as 'considered suitable for Pass Through Payment'. Available at: http://www.npc.co.uk/local_decision_making/resources/eoe_appendix3.doc. Accessed July 4, 2012

被引用文献 ( 2 ) 〈TOP〉

卢正宗(2017)。以社会认知理论探讨影响医院预算参与之前置因素。管理与系统，24(2)，259-302。
(2024)。以指标14天非计画再住院率和三天内急诊重返率探讨在台湾实行诊断相关群组的影响。管理与系统，31(3)，459-480。

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