摘要
目的分析秦皇岛市某三甲医院按病种分值付费的实施效果,以期为医院精细化管理及医保政策制定提供依据。方法收集2017年1月1日-12月31日出院患者住院病案首页及医保结算信息作为按病种分值付费政策实施前组,2018年1月1日-12月31日出院患者住院病案首页及医保结算信息作为按病种分值付费政策实施后组,采用描述性分析、秩和检验、卡方检验等进行两组分析。结果 2018年按病种分值付费34 492人次,占医保住院患者75.9%,基金共结余1974.53万元,医保患者次均费用较2017年按项目付费降低676.36元,差异具有统计学意义,P<0.001;平均住院日降低1天,差异具有统计学意义,P<0.001,城镇职工医保患者实际报销比例为71.7%,城乡居民患者实际报销比例为45.2%,重复住院率为20.7%,实际报销比例及重复住院率达标。结论按病种分值付费取得了一定成效,通过缩短平均住院日、降低患者次均费用、控制诊疗成本等精细化管理手段,增加医保基金结余。在实施过程中也发现了一些问题,建议医保管理部门应适时调整考核指标。
Objective To analyze on the implementation effects on Diagnosis-Intervention Packet in grade a class three hospital in Qinhuangdao. Methods The first page of medical records and medical insurance settlement information of discharged patients from January 1 to December 31, 2017 were collected as the pre-implementation group, and the medical insurance settlement information of discharged patients from January 1 to December 31, 2018 were collected as the group after the implementation of the disease score payment policy. descriptive analysis, rank sum test and chi-square test were used to analyze the two groups. Results In 2018, 34492 people were paid by Diagnosis-Intervention Packet, accounting for 75.9% of medical insurance inpatients,the accumulated surplus of fund amounted to 19.74 million, the average expenditure of inpatients with medical insurance was reduced by 676.36 compared with that in 2017, the average length of stay was decreased by 1 days, the actual compensation ratio of urban workers health insurance was 71.7%,that of urban and rural residents was 45.2%, the readmission rate was 20.7%, the actual compensation ratio and readmission rate were up to standard. Conclusion The hospital had certain achievement in the implementation of Diagnosis-Intervention Packet,increased the balance of medical insurance fund by shortening the average length of stay, reducing the average cost of patients, controlling the cost of diagnosis and treatment and so on,but some problems were found in the implementation process and It was suggested that medical insurance administration should adjust the examination index timely.
作者
蔡杰
Cai Jie(Insurance Management Office,The First Hospital of Qinhuangdao,Qinhuangdao 066000,Hebei Province,China)
出处
《中国病案》
2021年第4期28-30,共3页
Chinese Medical Record
关键词
按病种分值付费
实证研究
实际报销比例
重复住院率
Diagnosis-Intervention Packet
Empirical research
Actual compensation ratio
Readmission rate
