摘要
目的:通过整理和分析H医院DRGs付费方式改革与成效,尝试构建DRGs与医院管理的协同理论模型。方法:通过对H医院的管理文件进行梳理,理清DRGs与医院内部管理改革的逻辑关系;调取医院2017年9月—2018年12月的运行数据,选择发生占比前五位疾病为目标病种,通过医疗费用等指标评估改革成效。结果:临床路径人次覆盖率由45.32%上升到了60.74%,病案首页填报完整率由95.31%提升至99.01%,住院人次增长16.28%,医务人员人均绩效工资涨幅23.19%;排除医疗服务价格调整的影响,代表性疾病次均费用波动性下降,降幅为100~300元。结论:通过医保DRGs与医院协同管理系统环,H医院以效率提升、质量维持和成本降低验证了DRGs能够协同医院管理实现价值共创。
Objective:Through reorganizing the reform measures and analyzing the effectiveness of the DRGs payment methods in H hospital,this paper considers assessing whether the DRGs reform brings value to medical insurance and hospitals,and constructs a synergistic theoretical model of DRGs and hospital management.Methods:Through the management documents of H hospital,the logical relationship between DRGs and hospital internal management reform was clarified.Meanwhile,the 2017.9—2018.12 period s hospital operational data were retrieved,and the top five diseases were selected as the target diseases to evaluate the effectiveness of the reforms through indicators such as medical expenses.Results:The coverage rate of clinical pathways increased from 45.30%to 60.08%.The complete rate of report on the front page of the medical record increased from 95.31%to 99%,the number of hospitalized patients increased by 16.28%,and the per capita performance salary of medical staff increased by 23.19%.The effect of price adjustment on medical services was excluded.The average cost of major diseases received a decrease of 100~300 yuan.Conclusions:Through the combination of medical insurance DRGs and hospital collaborative management system loop,H hospital has verified that DRGs can achieve the value creation in collaboration with hospital management with efficiency improvement,quality maintenance and cost reduction,respectively.
作者
高红霞
李云萧
张研
陈迎春
刘洋基
王辉珠
司华
GAO Hong-xia;LI Yun-xiao;ZHANG Yan;CHEN Ying-chun;LIU Yang-ji;WANG Hui-zhu;SI Hua(School of Medicine and Health Management,Tongji Medical College,Huazhong University of Science and Technology,Wuhan Hubei 430030,China;Rural Health Service Research Center,Hubei Provincial Humanities and Social Sciences Key Research Base,Wuhan Hubei 430030,China;Huining People s Hospital,Baiyin Gansu 730700,China)
出处
《中国卫生政策研究》
CSCD
北大核心
2019年第11期23-28,共6页
Chinese Journal of Health Policy
基金
中央高校基本科研业务费专项基金(HUST 2018KFYYXJJ064)
中央高校基本科研业务费专项基金(HUST 2016YXZD030)
华中科技大学文科双一流建设项目基金
