• Quan ly - Trao ddi
Phirong thirc chi tra chi phi kham chira benh theo nhom chan doan lien quan (DRG) tai Viet Nam,
giai doan 2015-2019
Le Thanh Cong
FH Ke hogch Tai chinh, Bg Yti E-mail: congtcldia^yahoo. com Dat van de
Thyc hien Luat Bao hiem y tg sd 25/2008/QH12 ngay 14 thang 11 nam 2008 cua Qu6c hpi va Luat so 46/2014/QH13 ngay 13 thang 6 nam 2014^1 cua Quoc Hpi supa doi, bo sung mot s6 dieu cua Luat Bao hiem y te, viec thanh toan chi phi kham benh, ch&a benh (KCB) bao hiem y t4 (BHYT) se du-pc thifc hien theo 3 phu-ong thi/c chu ySu bao g6m thanh toan theo phi dich vu, thanh toan theo dinh suat va thanh toan theo nhom chan doan lien quan (Diagnosis -related group - DRG).
Bai viet nay nham giai thieu v4 phu'ong thi>c chi tra kham chi>a benh theo nhom chin doan lien quan (DRG), nhUng u-u diSm, l<huyet diem va 16 trlnh thyc hien ti> 2015-2019 a Viet Nam.
PhiFcng thirc thanh toan DRG va sy cin thilt phai ap dung
Thanh toan theo nhom chin doan lien quan (ORG) la tap hp-p mpt s6 nhom nho dai dien cho mpt s6 lu'ong Jon cac benh, trong do m§i nhom CO cac dac diem la cung co dac dilm lam sang tu'ong ty nhau va miFc dp sis dung nguon lu-c nhu- nhau PI.
Phu'ong thiPc chi tra (PTCT) theo DRG c§n phai du'ge nghien CLPU va thyc hien tai Viet Nam. Hien nay, phu-ong thipc thanh toan chi phi kham chUa benh (KCB) giO'a co quan BHYT va co so KCB chu ygu la phu-ong thuc phi djch vu. Voi phuong thiPC thanh toan nay, viec kiem soat chi phi la rit kho khan, boi vi ban chit cua phuong thifc chi tra theo phi dich vu se thuc day co so y t4 cung Cfng nhieu dich vu. Cang cung Cfng nhi4u djch vu thi co so- y tg se cang co lo-i, nhit la trong b6i canh cac CO so y t l dang thyc hien ty chu nhu hien nay. Do do, thanh toan theo phi dich vu co nguy co khuygn khich CO so cung ung dich vu y tg qua mu-c cin thigt, din den he qua la lam mit can doi thu chi, CO quan BHYT khong kiem soat dup-c chi phi v^
lang phi ngudn lye cua xa hpi. De giai quygt dupc nh&ng bit cap nay, Bp truong Bp Y te da ban hanh Quygt dinh s6 488/Qe-BYT ngay 9/2/2015 v l
xay dyng va then khai thi diem PTCT chi phi KCB theo DRG tai 5 tinh (Ninh Binh, Ha Nam, Quang Binh, Binh Duong va Ba Rja VQng Tau) trpng khoang thoi gian 5 nam (2015-2019).
Phuong thCpc thanh toan theo DRG se giai quygt dugc hang loat cac b i t cap trpng kiem spat chi phi, khuyin khich cung c i p dich vu co chit lugng va he thong thanh toan minh bach.
Sy ra dgi cua he thong DRG nhim d l cai thien tinh minh bach cua he thong thanh toan chi phi dich vu y t l cung nhy la cong cu d l danh gia, do luong san lugng cung img dich vu cua benh vien.
Viec phan chia cac chin doan vao ciing 1 nhom bang each phan loai benh co su' dung ngu6n lu-c va CO dac diem lam sang tugng ty nhau, giup he thong DRG co tae dung h5 trg danh gia chinh xac cac chi phi diiu tn cho mpt benh hoac mpt nhom benh nhit dinh, bap g i m ca s6 lugng dich vu sudung, loai chin doan lam sang va thu thuat, phiu thuat va cac dich vu da thyc hien. Do do, DRG CO the cho phep so sanh hieu suit cung cap dich vu cua cac benh, gop phin tang tinh minh bach trong hoach dinh chinh saeh, h i trg chiin lugc phat triln va d i u tu phii hgp vol xu huang tai chinh cong hien nay. Viee ap dung phuong thu-c ehi tra theo DRG se h i trg tinh dung, tinh du chi phi djeh vu y t l (DVYT) thee toan bp 7 ylu t6 chi phi bao gom: Chi phi lugng va phu cip cho can bg y t l ; Chi phi khau hao trang thilt bj y t l ; Chi phi khiu hao eo so ha ting; Chi phi dao tao - nghign ciru khoa hpc; Chi phi thulc, vattu- tigu hao, djch truyin, mau; Chi phi dien nu-d-c, thong tin lien lae, khu- khuan, xij- ly ve sinh moi tru-ong; Chi phi duy tu bao duong thilt bj. Neu ap dung gia tinh diy du 7 y l u t l chi phi nay se phan anh dung thyc trang chi phi eua tifng nhom benh, dam bao KCB cong bing, tang tinh minh bach va khuyin khich dugc cac don vj cung cip DVYT thyc hien t i t nhiem vu cua minh. Don vj nao cang cung c i p nhilu djch vu, co so lugng benh nhan dong se dugc ehi tra dung, du va phD hgp vol kit qua dat duoc.
TAPCHIDUOC r -
Quan ly - Trao doi
Uu d i l m , nhyo-c d i l m cua he thong DRG U'u diem cua PTCT theo DRG la eo the tang cuo-ng giam sat chit lugng djch vu, kilm soat chi phi, giam qua tai benh vien tuyin tren, chi tra BHYT duge thuan Igi... Viee ap dung DRG la rit kha quan voi he thing chi tra DVYT ngi tru tai cac benh vien hien nay. Bgi vi, PTCT theo DRGs la he thing ma vien phi dugc xac djnh dya vac benh (cac nhom chin doan lign quan- DRGs). He thong chi tra nay dugc ky vpng se the hien sy tilp can khac d l tao ra Igi ich dii voi cae nha quan ly thing BHYT bin vu-ng v l mat tai chinh. Tuy nhign, ban than phygng thifC DRG cung co tin tai mpt so dilm y l u nhu cae phuong thifc khae. Phin Ion cac diem ylu nay ed the duge xCf ly bing xay dyng ky thuat, chuan hoa cac djeh vu, chin doan va chinh sach ro rang, minh bach de han c h i tac hai va tang cuong diem manh cua phuong thifc P'.
Cac d i i u Icien cdn co d l t r i l n Ichai he thdng DRG
Dg trien khai he thing DRG, co so y t l c^n dap ifng cac diiu kien co ban bao gim he thing eong nghe thong tin, bieu miu thong nhit, nang lye can bg quan ly; bo-i vi, du- lieu cua cac benh vien hien nay la rit Ion. Du' lieu ein phai dugc XLP ly va phan tich phuc vu qua trinh xay dyng PTCT va truoc mit la quan ly benh vign. Vi vay phat triln he thing ccng nghe thong tin (CNTT) la uu tign hang diu d l tif do giup cho nha quan ly co t h i do luong va tinh toan chi phi diu ra cua benh vien '^"i. Cae CO so y t l triln khai he thong DRG cin co nang lye va phugng tien nhu hg thing cong nghe thong tin h i trg cung cip cac thong tin diu vao diy du va ehinh xac thong qua benh an dign tCf, eae phin mim CO the trich xuit eae so lieu theo bilu miu quy djnh. Cac thong tin eg ban bao gom: Hp va tgn, tuli, gioi, trpng lugng, chan doan benh chinh va chin dpan cac benh di kem theo dugc ma hoa theo ICD10 bin ky ty, thoi gian nim vign, kieu ra vign; cae djch vu ky thuat. VI vay he thing cong nghe thong tin trong cac co so y t l la hit sifc cin thilt d l quan ly thong tin benh nhan va ap dung phuong thCfc chi tra theo DRGs.
Trong nam 2015, Bp Y t l da xay dyng va triln khai thi dilm D l an ehi tra chi phi KCB thep DRG dugc phe duygt thep Quyit djnh s l 488/QD-BYT ngay 9/2/2015 eua Bp trudng Bp Y t l , bit diu triln khai thyc hien tif nam 2015 va kit thuc vao nam 2019 tai 5 tinh: Ninh Binh, Ha Nam, Quang Binh, Binh Duong va Ba Rja - Vung Tau. Vigc triln khai thi dilm la d l thu thap s l lieu ein thilt eho
phuong thCfc DRG co sy phoi hgp cua So Y t l , Phong Y t l , BHXH tfnh va cac benh vien tinh, huyen, tram y t l xa. Dy an thi dilm se dugc trien khai to-i nam 2019 chu trgng vao 5 tinh, them 4 tinh se tham gia vao nam 2017. Ngay tif nam diu tien thye hign da co khuyin nghj ring chit lugng s l lieu ein dugc cai thien va mpi s l lieu phai co sin a mli CO so y t l d l tao ra cae nhom chin doan lign quan phii hgp va xae djnh gia.
Lo trinh thiPC hien viec t r i l n Ichai he thdng DRG o- Viet Nam
Lp trinh thyc hien bit diu tif nam 2015 din 2019. Nam 2015, tap trung thu thap, xCf ly du lieu va tinh toan DRG cho cac benh vien eua tfnh Ninh Binh. Phii hgp vol chuygn gia Nhat Ban (NTT DATA) xay dyng he thing giam djnh ty dpng cho DRG tai tinh Ninh Binh. Nam 2016, triln khai DRG eho 4 benh vien tif 1/4/2016 bao gim: BVDK Ninh Binh va 3 BVDK huyen (Ygn Khanh, Kim Son va Hoa Lu). TCf 1/6/2016 trien khai DRG eho 16 co so t l cdn lai va chi tra chi phi KCB npi tru theo DRG tif Quy 111/2016 cho toan tinh Ninh Binh. Nam 2016 din 2019, thyc hien xay dyng va ap dung thi dilm DRG trgn 5 tinh thep O l an DRG da dugc phe duyet. Tif nam 2020, thong qua viec triln khai thi dilm, hoan thanh PTCT theo DRG d l triln khai tren dien rpng va tlln toi ap dung trgn toan quic, dua phuong thCfc nay tro thanh phuong thirc ap dung rpng rai, chilm ty trpng chi tra cao trong he thing chi tra, thanh quyit toan BHYT. Ding tho-i, viee tinh du cac ylu t l ciu thanh vien phi cung dugc xay dyng, ap dung trong hg thing DRG theo dung lp trinh va thoi han quy djnh.
Tai lieu tham khao
1. Luat Bao hilm y t l so 25/2008/QH12 ngay 14 thang 11 nam 2008 cua Quoc hoi va Luat s6 46/2014/
QH13 ngay 13 thang 6 nam 2014.
2. Fetter, R. B. (1991). Diagnosis Related Groups:
Understanding Hospital Performance. Interfaces, http://
doi.org/10.1287/inte.21.1.6
3. Cheng, S.-H., Chen, C.-C, & Tsai, S.-L. (2012).
The impacts of DRG-based payments on health care provider behaviors under a universal coverage system:
a population-based study Health Policy Amsterdam Nethertands, 707(2-3), 202-8. http://doi.Org/10.1016/j.
healthpol.2012.03.021
4. Aas, I. H. (1988). Quality of hospital data and DRGs. Scandinavian Joumal of Social Medicine, 76(4), 223-226.
{Ngay nhan bai: 22/10/2016 - Ngay phan bien: 10/11/2016 - Ngay duyet dang: 02/12/2016) TAPrtif PiM^iiif>^ .-/-...^^oA .^o^,I»,^^y