Research on the development and management of clinical pathways Ⅲ: thoughts on the work of clinical pathways under the DRG/DIP payment model of medical insurance payment

Abstract

China is actively promoting Diagnosis-Related Group (DRG)/Diagnosis-Intervention Packet (DIP) payment reform alongside the implementation of clinical pathways. While existing research has explored the impact of DRG/DIP reform on healthcare service behaviors and public health, there is limited investigation into the synergistic mechanisms between clinical pathways and healthcare payment reform. China currently faces challenges in implementing both DRG/DIP payment reform and clinical pathways. However, given that both aim to control medical costs and improve the quality of care, they possess a high degree of compatibility. This paper examined the content of healthcare payment reform and delve into how clinical pathways and payment reform can achieve synergistic effects. It further explored how clinical pathways and DRG/DIP can be deeply integrated to maximize their combined impact, providing valuable insights for the application and promotion of DRG/DIP payment and clinical pathways.

Keywords

• payment by diagnosis-related group
• payment by diagnosis-intervention packet
• healthcare payment reform
• clinical pathway
• hospital management