价值医疗导向的DRG支付对重症肝病诊疗的影响*

doi:10.3969/j.issn.1672-5069.2026.01.001

实用肝脏病杂志 ›› 2026, Vol. 29 ›› Issue (1): 1-4.doi: 10.3969/j.issn.1672-5069.2026.01.001

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价值医疗导向的DRG支付对重症肝病诊疗的影响^*

焦婧然, 徐曼曼, 陈煜

100069 北京市首都医科大学附属北京佑安医院肝病中心四科(焦婧然,徐曼曼,陈煜);临床流行病学与临床试验学系(焦婧然)

收稿日期:2025-11-03 出版日期:2026-01-10 发布日期:2026-02-04
通讯作者: 陈煜,E-mail:chybeyond1071@ccmu.edu.cn
作者简介:焦婧然,女,23岁,硕士研究生。E-mail:jiaojingran@mail.ccmu.edu.cn
基金资助:
^*北京肝胆相照公益基金会人工肝专项基金资助项目(编号:iGandanF-1082024-RGG068)

Impact of diagnosis-related group payment on the diagnosis and treatment of patients with severe liver diseases from the point of view of value-based medicine

Jiao Jingran, Xu Manman, Chen Yu

Section Four, Center of Liver Diseases, You’an Hospital, Capital Medical University, Beijing 100069, China

Received:2025-11-03 Online:2026-01-10 Published:2026-02-04

摘要/Abstract

摘要： 在价值医疗导向下,疾病诊断相关分组(DRG)支付制度被视为推动医疗服务质量和效率提高的重要工具,已在全球广泛应用。然而,DRG的有效运行还依赖于疾病特征与支付规则之间的匹配程度。重症肝病具有高复杂性、高风险和高资源消耗等特点。现行DRG付费模式难以充分反映诊治疾病的真实成本结构,导致部分医疗机构面临亏损风险。国际经验显示,DRG制度的优化包括风险分层、动态调整和新技术补偿机制,以平衡成本控制与临床价值。我国在支付方式改革方面也已进行了初步探索,呈现出从费用约束向价值导向的转变趋势。本文旨在从价值医疗导向下梳理DRG支付与重症肝病诊疗的适配性,为完善我国相关支付政策提供参考建议和启示。

关键词: 重症肝病, 疾病诊断相关分组, 医保支付, 价值医疗

Abstract: Under the framework of value-based healthcare, the diagnosis-related group (DRG) payment system has been recognized as a key mechanism for enhancing healthcare quality and efficiency, and it has been widely implemented all over the world. However, its effectiveness mainly depends on the alignment between disease characteristics and payment rules. Severe liver diseases are characterized by high clinical complexity, substantial risks, and intensive resource utilization. The current DRG payment model often fails to capture the true cost structure of such conditions, leading to financial deficits in some medical institutions. It suggests that the optimization of DRG systems should incorporate risk stratification, dynamic adjustment, and additional reimbursement mechanisms for innovative technologies to balance income control with clinical cost burdens from international experience. In China, preliminary reforms have demonstrated a gradual transition from cost containment toward value-based payment approaches. This review is aimed at discussing the current knowledge on the compatibility between DRG payment models and the management of severe liver diseases from a value-based healthcare perspective, to provide theoretical insights and policy recommendations for refining China’s payment system.

Key words: Severe liver disease, Diagnosis-related groups, Health insurance payment, Value-based healthcare

焦婧然, 徐曼曼, 陈煜. 价值医疗导向的DRG支付对重症肝病诊疗的影响^*[J]. 实用肝脏病杂志, 2026, 29(1): 1-4.

Jiao Jingran, Xu Manman, Chen Yu. Impact of diagnosis-related group payment on the diagnosis and treatment of patients with severe liver diseases from the point of view of value-based medicine[J]. Journal of Practical Hepatology, 2026, 29(1): 1-4.

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价值医疗导向的DRG支付对重症肝病诊疗的影响^*

Impact of diagnosis-related group payment on the diagnosis and treatment of patients with severe liver diseases from the point of view of value-based medicine

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