Asian Journal Of Social Pharmacy

Abstract: Objective To study the successful experience of implementing diagnosis related group (DRG) payment system in the United States and provide a reference for China’s reform of health insurance payment. Since the United States is the first country to develop and apply the DRG in the world, its research and practice of DRG are always at the forefront. Methods Literature research method was used to investigate DRG payment system, the specific steps of the payment, the setting method of relevant indicators, and the quality supervision measures. Results and Conclusion There are mainly three aspects from the experience of DRG payment system in the United States. Firstly, the government’s responsibility for health insurance is clarified. Secondly, the relevant indexes are set reasonably. Thirdly, the DRG weight and base rate are adjusted dynamically to ensure the fairness of DRG payment. Therefore, China should pay attention to the following three aspects: clarifying the main responsibility of the government in the reform of health insurance payment, establishing the quality control system of the first page of medical records, and improving the supervision mechanism for medical quality.

Key words: diagnosis related group, health insurance payment system, US, enlightenment