[健康保险和诊断相关小组的使用]。

Sovetskoe zdravookhranenie Pub Date : 1991-01-01
V A Boiadzhian, V O Shchepin
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引用次数: 0

摘要

发展我国的保险医学,可能是改善人口健康保护措施的途径之一。这是一个治疗和预防措施体系,通过公民支付保险费,在雇主、雇员和国家补助的目标支付的基础上实现。保险医学的国际经验表明,现有的根据基本诊断进行疾病分组的原则已不能提供资源的有效利用,对医院绩效结果的评估也不够精确。在寻找解决这一问题的方法的过程中,有必要采用一种方法,根据诊断相关疾病组(DRG)来评估治疗和预防机构的财政和经济活动,这些疾病组将具有大致相同的检查和治疗技术的类似疾病病例联合起来,因此治疗费用相同。这一制度起源于美国,在西欧许多国家得到广泛应用。在DRG系统的帮助下,卫生机构可以获得关于治疗结果、治疗费用和发展前景的更全面的信息。采用DRG制度可以改善各机构的财务和经济业绩,并与实施健康保险方案的组织合作。
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[Health insurance and use of diagnostic related groups].

One of the ways to improve measures aimed at population health protection may be the development of insurance medicine in our country. This is a system of curative and preventive measures realized through insurance payments made by citizens and on the basis of target payments by employers, employees and state grants. The international experience of insurance medicine indicates that the existing principle of grouping diseases according to the basic diagnosis no longer provides the effective use of resources and not precisely enough assess to the outcomes of hospital performance. The search of ways to solve this problem led to the necessity of using the method of assessing financial and economic activities of curative and preventive institutions on the basis of diagnosis related groups of diseases (DRG) which unite the cases of similar diseases having approximately the same technology of examination and treatment of patients and consequently the same cost of treatment. This system originated in the USA and is widely used in many countries of Western Europe. With the help of DRG system health institutions can acquire more full information on the results of treatment, costs of treatment and prospects for development. The introduction of DRG system permits to improve the financial and economic performance of institutions and to collaborate with organizations realizing health insurance programmes.

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