1, the foothold of paid design is different. Drg pays attention to case combination, which embodies the role of medical institutions in standardizing the diagnosis and treatment path of cases with the same disease and operation, and plays an incentive and constraint role in medical insurance payment. Dip focuses on the combination of diseases, and according to the functional orientation of medical institutions at all levels, it reflects the guiding role of treatment methods and reasonable expenses through the differences in scoring different diseases;
2. Different grouping principles. Drg is from coarse to fine, emphasizing on the basis of clinical experience and starting from the categories of disease diagnosis. According to the diagnosis and treatment methods, they are divided into different case combinations, "multi-disease group" or "multi-operation group", and there are great differences between groups. Dip, from fine to coarse, emphasizes the statistical analysis of clinical objective and real data. According to the characteristics of diseases and treatment methods, "one disease, one operation and one group" has little difference within the group;
3. There is a difference between the rate and the integral value. The calculation of drg payment standard is the calculation of relative weight and rate, and the calculation of dip payment standard is divided into disease score and score.
4. There are differences in supervision difficulty. The grouping process of drg is highly dependent on classifiers and experts, and the diagnosis and treatment methods and paths of medical institutions at all levels are quite different. It is risky to determine the total number of medical institutions at the same level subjectively according to the indicators. Dip relies on historical medical record data, which leads to the risk of inducing medical institutions to adopt complex technology and high-scoring treatment methods, and it is difficult to supervise medical insurance.
legal ground
People's Republic of China (PRC) social insurance law
Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity. Article 4 Employers and individuals who pay social insurance premiums according to law in People's Republic of China (PRC) have the right to inquire about payment records and personal rights and interests records, and ask social insurance agencies to provide social insurance consultation and other related services. Individuals enjoy social insurance benefits according to law and have the right to supervise the payment of their own units.