研究背景：自2017年以来，国家医保局实行了一系列的医保支付改革措施，DRG医保支付改革作为目前医保支付改革的工具备受关注。目前，我国已经对30个城市进行了DRG的试点工作，表明了我国对传统按项目付费的方式进行改革的决心。研究目的：DRG医保支付模式可能影响到医生对诊疗过程中医疗资源的利用与医疗决策，从而影响到组织承诺和绩效，一旦与医生的个人利益挂钩，医生的决策可能会因此发生变化，从而会影响到医疗服务质量。本文旨在探究DRG改革对医生行为产生的正向及负向的影响，并对此提出相应建议。研究方法：系统检索公开发表的有关DRG对医务人员行为的影响的中英文文献，通过系统评价对于该课题相关的文献定性进行描述性综合分析，通过Meta分析对于该课题相关的文献进行统计数据的定量分析，并以定性和定量分析的结果为依据来设计问卷进行实证研究，从而探究出DRG医保支付改革对于医务人员的行为的影响。研究结果：（1）问卷结论与系统评价及Meta分析的部分结论相互验证：DRG改革后，医务人员更认同他们对手术指征的控制比以往更加严格、使用昂贵的新尖端技术的情况有所减少、减少了昂贵耗材的使用。（2）问卷结论并不能验证以下Meta分析的结论：将部分诊疗费用转成自费，治疗更加符合临床路径，门诊费用被转移，优化治疗流程，增加入院次数，增加自付药物的使用。（3）性别、学历、职级、工作年限对于DRG改革后的医生行为有显著影响。年龄、科室对DRG改革后的医生行为无显著影响。
Research background: Since 2017, the National Health Insurance Bureau has implemented a series of medical insurance payment reform measures, and the DRG medical insurance payment reform as a tool for current medical insurance payment reform has received much attention. Currently, China has conducted DRG pilot work in 30 cities, demonstrating China‘s determination to reform the traditional project based payment method.Research objectives: The reason why the DRG can influence the behavior of medical personnel is that this payment model may affect the utilization of medical resources and medical decision-making by doctors during the diagnosis and treatment process, thereby affecting organizational commitment and performance. Once linked to the personal interests of doctors, doctors‘ decision-making may therefore change, which may affect the quality of medical services. This article aims to analyse the influence of DRG reform on the behavior of doctors, explore its positive and negative impacts, and propose corresponding suggestions.Research methods: Search publicly published Chinese and English literature on the impact of DRG on the behavior of healthcare workers, conducts descriptive comprehensive analysis of literature related to this topic through system evaluation, conducts quantitative analysis of statistical data on literature related to this topic through meta-analysis, and designs questionnaires for empirical research based on the results of qualitative and quantitative analysis, in order to analyse the influence of DRG reform on the behavior of doctors.Research conclusion:（1） The conclusion of the questionnaire is mutually validated with some conclusions from system evaluation and meta-analysis: After the DRG reform, medical staff are more convinced that their control over surgical indications is stricter than before, and the use of expensive cutting-edge technologies has decreased, reducing the use of expensive consumables.（2） The conclusion of the questionnaire does not validate the conclusions of the following meta-analysis: converting some diagnosis and treatment costs to self payment, making treatment more in line with the clinical pathway, transferring outpatient costs, optimizing treatment processes, increasing hospital admissions, and increasing the use of self paid drugs.（3） Gender, education level, job rank, and years of work have a significant impact on the behavior of doctors after the DRG reform.（4） Age and department have no significant impact on the behavior of doctors after DRG reform.
