国家卫生计生委卫生发展研究中心 China National Health Development Research Center

http://www.nhdrc.cn

中国按疾病诊断相关分组收（付）费规范的研制与展望

于丽华 Yu Lihua

国家卫生计生委卫生发展研究中心 National Health Development Research Center, NHFPC

2015年10月，巴黎 Oct.2015, Paris

Development and prospects for pricing and payment

regulation on China’s diagnosis-related groups (CN-DRG)

一、中国支付制度改革背景介绍

Background of Payment System Reform in China

二、中法双方前期在DRG领域的合作

China France Previous Cooperation in DRG Development

三、中国DRG收（付）费系统开发简介 Brief Introduction of CN-DRG Development by CNHDR

四、中法未来合作展望

Prospects for Future Cooperation between CNHDRC and French Counterparts

内 容 Outline

一、中国支付制度改革背景介绍

Background of Payment System Reform in China

当前全国公立医院经济总体运行特点与问题Characteristics of economic operation of health facilities

1.由于政府财政对医院（公立医院）补偿不足，医疗服务的价格低于成本价

格，“以药补医”成为当前公立医院补偿机制的主要特征。

Due to insufficient government subsidy for public hospitals, prices are below cost price for

medical procedures and service, the "over-description of drugs compensation for medical costs”

mechanism becomes the main feature of public hospitals.

2. 我国医院实行按项目付费，技术劳务价格偏低，难以调到合理水平。医

院趋利行为造成大处方、大检查较为普遍，费用控制成为难题。

FFS is the major hospital payment method in China, Low prices of health procedures and

labor which are hard to redress to reasonable levels. Profit-driven behavior results in abuse of

drugs, lab tests and consumables, cost containment is a big challenge.

3.医疗机构的补偿过多地依靠药品和耗材收入。 Health institution reimbursement over-depends on revenues from medicine and consumable

materials

－－对现行的医院支付制度进行改革成为当前我国医改的主要任务之一。 The provider payment system reform has become one of the main tasks of the current health

care reform.

我国支付方式改革演进策略 Evolution of payment reform in China

简单单病种付费 Per case for simple

illness

DRG

第一阶段

Stage 1

第二阶段

Stage 2

第三阶段

Stage 3

按项目付费FFS

按住院床日付费

Per diem

按住院单元付费

Per episode

按人头付费Capitation

按项目付费FFS

其他付费方式

Other methods

按服务项目打包付费（项目规范）

FFS for bundles services（Fee Schedule）

复杂单病种付费 Per case for

complex conditions

公立医院支付制度改革趋势 Trends of PPM reform in public hospitals

• 趋势：从按项目付费到按人头、按病种、按床日付费最终发展成为“住院支

付以DRG为主，按项目、按床日和按人头多种支付方式并存”的体系。

Trend: PPM will be transformed from FFS, capitation, per diem, case payment to mixed

payment system dominated by DRG, together with FFS, per diem and capitation.

• 创建一个具有自主知识产权的“中国DRG收（付）费体系”成为医改重要内

容。

To develop CN-DRG with our own intellectual property rights has become one of the important

part of the current health care reform.

法国DRG体系 DRG System in France

• 法国是世界上在全国范围内推行DRG支付医疗费用最成功的国家之一。

France is one of the most successful counties in DRG payment system.

• 法国卫生部医疗服务总局是法国推行DRG支付医疗费用的领导部门，该部下

属的医院保健信息分局（ATIH）是法国负责研究与实施DRG的核心研究与管

理机构，在DRG定价、支付和监管领域有着丰富的经验，对我国开发DRG系

统、实施、监管（含医院质量管理）与评价有着重要的参考价值和借鉴意义

。

DGOS is the leader department of GHM in France, ATIH is the key research and management

institute responsible for the DRG research and implementation, which has rich experiences on

DRG pricing, payment and monitoring field and make valuable references for our CN- DRG

design，practice, investigate(including hospital quality management) and evaluation.

二、中法双方前期在DRG领域的合作

China France Previous Cooperation in DRGs Development

卫生发展研究中心自2009年起与法国卫生部建立了友好合作关系。 Since 2009, CHNDRC has set up good relationship with MOH of France.

• 2010年6月，我方主办的DRGs研究与应用高层研讨会上，法国的米歇尔·布莱蜜进行了“法国医疗支付制度的改革与实施”发言。

Jun. 2010, CNHDRC held DRG Research and Implementation Summit , Félix Faucon from French Ministry of Health delivered a speech on “French Health Payment System Reform and Implementation” .

• 2010年11月，卫生发展研究中心与法国卫生部医疗服务总局共同签署

了“关于卫生筹资、医院信息系统和卫生政策评估领域的合作谅解备忘

录” Nov, 2010, NHDRC signed the MOU of the “Cooperation in health care financing，hospital

information system and health policy evaluation “with MOH of France.

----双方主要合作领域包括共同开展医院补偿与筹资体系、医疗信息分类与编码

、医院成本核算研究；共同开展卫生领域培训项目，并交换访问学者和专家 The main area of cooperation includes: research on hospital reimbursement and financing,

classification and coding of health information, cost-accounting of hospital as well as

training program in health care system and exchange of experts and scholars .

• 2010年12月，法国卫生部专家到访北京，与原卫生部财务司及发展中心工作人员共同撰写完成《法国医疗卫生体制改革对我国医改的启示》，提交原国家卫生部。

Dec. 2010, Experts from French Ministry of Health visited Beijing and worked together with staff from NHFPC and CNHDRC to develop the report on “Health system reform in France, experiences and lessons to health reform in China” . The report were submitted to NHFPC

• 2011年2月，法国专家Carine Milcent 在中心进行了关于“法国DRGs及实施”的讲座。

Feb.2011, French experts Carine Milcent visited CNHDRC and make a lecture on “French DRG and Implementation”

• 2014年9月，国家卫生计生委、国家发展改革委领导和发展中心研

究人员共同赴法国卫生部、医院保健信息局及医疗机构参观访问。

就法国的卫生服务提供体系、医疗服务、药品耗材定价，法国DRG

支付体系的总体情况进行了全面考察。

Sep.2014, NHFPC, NDRC and CNHDRC officials and researchers

are invited to visit French Ministry of Health, ATHI and French

health facilities to fully understand French healthcare providing

system, health care services, drug and consumable pricing, and DRG

system.

• 2015年4月，法国卫生部医疗服务总局局长桑德里娜·碧叶女士带队来京，与发

展中心开展为期一周的DRG技术交流研讨活动。

Apr.2015, Sandrine Billet, Director from DGOS took a group of DRG experts to

China to conduct one week DRG technical exchange.

• 中法双方专家持续在DRG收（付）费研究领域进行交流和互访，对制定中

国国家DRG收（付）费规范具有重要的借鉴意义。 China and France continuing conduct exchange activities on DRG field

which make great significances on China DRG development.

三、中国DRG收（付）费系统开发简介

Brief Introduction of CN-DRG Development by

CNHDRC

三、中国DRG开发简介 Brief Introduction of CN-DRG Development by CNHDRC

• 2008年起，国家卫生计生委财务司委托中心牵头成立《全国按疾病诊

断相关分组收（付）费规范》大型课题组。

Commissioned by Dept. of Finance of NHFPC, led by CNHDRC, large research project

group of “Regulation on pricing and payment of CN-DRG” was established in 2008.

• 期望创建一套符合国情、全国统一的DRGs分组和权重赋值以及与之

配套的管理制度的目标，为公立医院提供适宜的收（付）费方式和制

度体系。

Aimed to establish unified national DRGs grouping and relative weights in line with

national conditions, as well as compatible management and supporting systems, to

provide appropriate payment system for public hospitals.

由卫生计生委财务司、发改委牵头，是国家收（付）费系列

规范之一。“Regulation on pricing and payment of CN-DRG” was lead by Dept. of

Finance of NHFPC and National Development and Reform Commission (NDRC), and it is

one of the series regulations on pricing and payment

2014.10.13 李斌主任对本项工作的批示 Comments from DG of Dept. of Finance, NHFPC

（一）强有力的技术保障Strong Technical Support

1. 由卫生计生委财务司李斌司长和卫生发展研究中心名誉主任张振忠教

授牵头的核心项目专家团队，共计21人。

The core project team, is led by Prof. Zhang Zhenzhong, Honorary Director of CNHDRC,

and Mr. Li Bin, the DG of Dept. of Finance, NHFPC, consists of 21 core experts.

2.有来自全国13个省市物价和支付、卫生的政策专家。

13 local pricing and payment experts, as well as health policy experts.

3.有全国各专业学会主任委员或副主任委员牵头的庞大的临床专家团队

，共有35个专业735位临床专家。

A large team of clinical experts consist of a total of 35 professional specialties and 735

clinical experts, each specialty led by chairman or vice chairman from national

professional institutes.

中国DRG收（付）费分组的特征 Characteristics of CN-DRG Grouping

国家卫生计生委财务司颁发的

临床专家咨询组专家聘书 Letter of appointment for clinical experts as Advisory

Group members by Dept. of Finance, NHFPC

临床咨询专家地区分布 Regional Distribution of Clinical experts

序号 七大区Area 省份Province

统计No. 百分比%

序号 七大区Area 省份Province

统计No. 百分比%

1

华东区

East China

江苏 12 1.63% 19

西北区

North-west

China

宁夏 3 0.41%

2 安徽 3 0.41% 20 新疆 3 0.41%

3 浙江 21 2.86% 21 青海 1 0.14%

4 福建 9 1.22% 22 陕西 28 3.81%

5 上海 36 4.90% 23 甘肃 3 0.41%

6 山东 18 2.45% 小计Subtotal 38 5.17%

小计Subtotal 99 13.47% 24

西南区

South-west

China

四川 16 2.18%

7 华南区

South China

广东 34 4.63% 25 云南 2 0.27%

8 广西 2 0.27% 26 贵州 2 0.27%

9 海南 0 0.00% 27 西藏 0 0.00%

小计Subtotal 36 4.90% 28 重庆 12 1.63%

10 华中区

Central

China

湖北 31 4.22% 小计Subtotal 32 4.35%

11 湖南 16 2.18% 29 东北区

North-east

China

辽宁 15 2.04%

12 河南 12 1.63% 30 吉林 4 0.54%

13 江西 5 0.68% 31 黑龙江 8 1.09%

小计Subtotal 64 8.71% 小计Subtotal 27 3.67%

14

华北区

North China

北京 397 54.01%

合计Total

735 100.00%

15 天津 22 2.99%

16 河北 10 1.36%

17 山西 6 0.82%

18 内蒙 4 0.54%

小计Subtotal 439 59.73%

4.有16家医院组成的试验基地：其中，中央级5家，省级4家，市级2家，

县级3家，部队医院2家。

16 pilot hospitals at different levels: 5 at the central level, 4 provincial, 2 municipal, 3

county, two military hospitals.

5. 受国家卫生计生委财务司委托，建立了“全国医疗服务价格和成本监测

网络”，收集全国各级各类医疗机构数据，2015年医院数已达到949家

，占全国医疗机构的3.84%。

Commissioned by the Dept. of Finance, NHFPC, “National M&E networks for price and the

cost of medical procedures and services” were established to gather data in all types of

medical facilities at all levels. In 2015, 949 hospitals, accounting for 3.84% of total

hospitals in China are involved.

（二）在WHO的ICD10疾病分类框架下建立临床疾病诊断一病一码的编码

体系，规范全国分组工具，全国权威专家进行论证

Establish the diagnosis terminology based on ICD-10 disease classification which was

developed by WHO. In the diagnosis terminology, each diagnosis was designated a unique

code, it will be used as a unified DRG grouping tool at the domestic level and it was verified by

national experts.

－－基于中国临床实际情况，组织700余名临床专家开始创建供一线临床医生使用

的、符合临床医生逻辑思维、用于临床学术交流的、全国统一的中英文的临床疾病

诊断名称术语集，并由临床专家对其与进行对接，经过全国专家论证后推广应用，

并且作为中国DRG收（付）费分组的主要工具之一。

Based the clinic, NHDRC organized over 700 clinic experts to development the diagnosis

terminology with regulated bilingual terminology (in Chinese and English) for clinical practice

and clinical communication which are logic clinically. The terminology was mapped into ICD-

10 classification system by experts. After the argumentation by clinical expert, the terminology

will be one og the main tools for DRG grouping.

（三）使用中国自主创新的中国医疗服务操作项目分类编码：

Use 11327 Chinese Classification of Health Interventions (CCHI) codes with Chinese

characteristics for procedures and fee schedule

－－卫生发展研究中心于2006年开始创建具有中国自主知识产权的中国医疗服务

操作项目分类与编码

CNHDRC Developed CCHI with our own intellectual property since 2006.

－－该套编码已经被中国卫生信息标准专业委员会立为行业标准，即将颁布

CCHI will be used as national industrial health standard in the future.

－－将CCHI操作编码应用于价格项目收费编码，收费编码已于2012年5月由三部

委在全国颁布实施，

CCHI was used in nation fee schedule which was issued in May 2012

－－首次创建了国际上操作码与收费码“两码合一”的应用规则

Initiated the combination of the procedure classification code and charge code into one system

（四）开发原则：结合多国经验，确定中国DRG分组：临床相似性为主，

兼顾资源消耗（临床专家法+数据分析法）

Development principles: based on multi-country experiences, CN-DRG groups developed with

the priority of clinical similarity, taking into account the resource consumption (Clinical

experts analytical method+data analytical method)

（五）由全国949家医院构建了价格和成本监测网络，在此基础上，逐步

统一和规范中国公立医院成本核算方法，逐步发展成为中国DRG成本

监测中心

Based on 949 public hospitals’ pricing and cost accounting monitoring and supervision

network, we will standardizing cost accounting methods in DRG system

（六）DRG覆盖的范围：Scope of DRG

－－包括县及县以上医疗机构

Including: hospitals at county hospital level and above

－－包括住院治疗 including acute inpatient care

－－包括日间手术 including ambulatory surgery

－－DRG顶层设计中包含了符合中国治疗特色的内容，如中医。

DRG contains a top-level design characteristics in line with China's treatment model,

e.g., TCM is included

－－不含在门诊治疗的疾病（如齿科）

Excluding: conditions & diseases treated in outpatient setting (e.g., dentistry)

中国DRG收（付）费分组的目前完成的情况

Current achievements of CN-DRG grouping

1.全国按疾病诊断相关分组收（付）费规范产出

Output of “Regulation on pricing and payment of CN-DRG”

分组标准 grouping standard

分组权重标准（各个DRG组的收付费相对点数）；grouping weights

standards

基础费率的计算政策说明。policy instruction of base rate

以上三点全国必须统一，各个省市自治区可以制定不同的费率（具体价格）

above 3 issues should be natioanl unified ,rates (concrete prices) can be set in different

provinces, municipalities and autonomous regions

中国疾病诊断规范名称术语集China Diagnosis terminology

2.完成了DRG 收（付）费的数据分组（958组）

Completed the grouping part of CN-DRG（ 958 groups）

－－选取839家2012-2013年两年病案首页3400万条数据，进行分组

Except for clinical involvement, Grouping was also based on 34 million

medical records data from 839 hospitals in the year of 2012 and 2013

－－基本组456组，细分组958组

Defining adjacent groups: 456 groups; groups:958 groups

序号No. 国家Country DRGs基本组数No.

of adjacent groups

DRGs细分组数No.

of final groups

1 美国 USA 308 748

2 澳大利亚 Australia 397 691

3 德国 Germany 595 1194

4 法国 France 586 2344

中国 China 456 958

3.目前正在进行临床分组验证 Clinical experts grouping demonstration meetings

儿科专业疾病诊断名称论证会

Pediatrics

骨科专业疾病名称专家论证会

Orthopaedics

神经专业疾病名称专家论证会

Neurology

肾内专业疾病名称专家论证会

Nephrology

临床专家分组讨论 clinical group discussions

四、中法未来合作展望

Prospects for Future Cooperation between CNHDRC and

French Counterparts

四、中法未来合作展望 Prospects for Future Cooperation between CNHDRC and French

Counterparts

• 希望DRG研究与支持项目变成一个持久合作项目，在前期

两国部级合作的基础上，上升到中法国家层面的合作。

Hope DRG Project become a long-lasting national-level cooperation projects between the two countries on the basis of pre-ministerial cooperation.

• 希望得到法国相关机构和专家们一始既往的支持。

Hope to get ongoing support from French agencies and experts.

– DRG的政策制定、推广、应用领域、制度建设（财务、医保、质量管理）、管理流程、师资培训。

DRG policy development, roll-up, applications, system construction (financing, health insurance, quality management), management processes, training of trainers.

– 在实践DRG时，如何确定医疗服务、药品和耗材的定价和价格调整机制。

When practicing DRG, how to set pricing and price adjustment mechanism of medical procedures and services, drugs and medical devices.

预祝会议圆满成功！ Wish the conference a complete Success!