ABSTRACT
DRG-based prospective payment system ( DRG-PPS ) is one type of mature inpatient care payment mechanisms in most countries and pilot projects would be introduced to China in 2017. This article provides an overview of the previous typical DRG-PPS reform initiatives on provincial, municipal and county level respectively. It also summa-rizes the characteristics of the reform programs, describes the diversities of policy implementation, and discusses the suc-cessful experience and implications of the initiatives. The paper puts forward some suggestions on the upcoming DRG-PPS pilot projects based on the progress and problems of the initiatives, to promote the DRG-PPS reform in China.
ABSTRACT
Objective To establish a model of DRG-like grouping of cesarean section patients in the Beijing area so as to observe its feasibility of controlling rising medical costs.Methods DRG-like grouping of cesarean section patients was conducted by case-mix/DRG.The patients were divided into 3 groups according to complications: the serious complication group,the moderate complication group,and the minor or no complication group.Results The rate of cesarean sections remained at 50% or so in Beijing.A statistical analysis showed a significant difference between the 3 groups in costs and length of hospital stay.70% of the cases in the serious complication group belonged to the high cost group whereas 70 % of the cases in the minor or no complication group belonged to the low cost group.Conclusion The main ways of controlling rising costs for cesarean sections include reducing the rate of cesarean sections and(adopting) DRG-like PPS payments in view of the nature of medical insurance and government payments for cesarean sections.