Dip and drg medical insurance have the following differences:
1. The payment design has different footholds. DRG focuses on case combinations as a unit, reflecting the guiding role of medical institutions in standardizing the diagnosis and treatment path of "same disease and same operation" cases, and exerting the incentive and restraint effect of medical insurance payment. dip focuses on disease combinations as a unit, based on the functional positioning of medical institutions at all levels, and reflects the guiding role in treatment methods and reasonable costs through the differences in scores assigned to different diseases;
2. Grouping The principles are different. drg goes from coarse to fine, emphasizing that it is based on clinical experience and starts from the broad categories of disease diagnosis. Case groups are divided into different groups according to diagnosis and treatment methods, "one group with multiple diseases" or "one group with multiple operations", with large differences between groups. dip goes from fine to coarse, emphasizing the statistical analysis of objective and real clinical data, grouping according to the unique characteristics of diseases and treatment methods, "one disease and one operation in one group", with small differences within the group;
3. There is a difference between the rate and point value. The calculation of drg payment standard is the calculation of relative weight and rate respectively, and the calculation of dip payment standard is divided into disease score and point value calculation;
4. There are differences in supervision difficulties. The DRG grouping process relies heavily on groupers and experts. The diagnosis and treatment methods and paths of medical institutions at all levels vary greatly. The total amount of medical institutions of the same level is subjectively determined based on indicators, and the fund risk is relatively high. DIP relies on historical medical record data, which risks inducing medical institutions to adopt complex technologies and high-scoring treatment methods, making medical insurance supervision more difficult.
Legal Basis
"Social Insurance Law of the People's Republic of China"
Article 2 The state establishes basic pension insurance, basic medical insurance, work-related injury insurance, Social insurance systems such as unemployment insurance and maternity insurance guarantee citizens' rights to obtain material assistance from the state and society in accordance with the law in the event of old age, illness, work injury, unemployment, childbirth, etc.
Article 4 Employers and individuals within the territory of the People's Republic of China and the People's Republic of China pay social insurance premiums in accordance with the law and have the right to inquire payment records and personal rights records, and require social insurance agencies to provide social insurance consultation, etc. Related Services. Individuals enjoy social insurance benefits in accordance with the law and have the right to supervise the payment of contributions by their units.