摘要
目的在疾病诊断相关分组(diagnosis related groups,DRG)付费下对某三级中医医院(简称中医院)和三级综合性医院(简称综合性医院)病例数排名前10病组的病例组合指数(case mix indicate,CMI)、费用消耗指数、时间消耗指数、高倍率占比等指标做对比分析,指导医院科学管理费用;同时为医保经办机构实施DRG付费提供参考。方法提取2021年某市一家三级中医院和三级综合性医院同期DRG数据,中医院19578例,综合性医院55701例,运用DRG相关指标做对比分析。结果中医院前10个病组有1个病组其权重(即该病组以往平均费用与当地全部病组平均费用之比)>1.5,费用消耗指数有3个病组>1,时间消耗指数有2个病组≥1,高倍率占比在0.00%~1.48%;综合性医院前10个病组中有2个病组权重>1.5,费用消耗指数有两个病组>1,时间消耗指数均<1,高倍率占比在0.00%~1.68%;前10个病组的平均CMI:中医院和综合性医院均为1.05;平均费用消耗指数:中医院0.94,综合性医院0.89;平均时间消耗指数:中医院0.85,综合性医院0.68;高倍率占比:中医院0.45%,综合性医院0.32%。结论整体看两家医院前10个病组费用管理均较好,综合性医院效益效率好于中医医院。DRG工具不仅能实现医保基金支付功能,还能有效评价各医院医疗效率、效益水平,方便医院做好费用管理。也提醒医保经办机构在实施过程中考虑到中医治疗的特殊性,使DRG付费更合理、公平。
Objective To evaluate the case mix index(CMI)of the top 10 disease groups in a tertiary traditional Chinese medicine hospital(referred to as traditional Chinese medicine hospital)and a tertiary general hospital(referred to as general hospital)under the payment of disease diagnosis related grouping(DRG),cost consumption index,time consumption index,high rate ratio and other indicators to make a comparative analysis to guide the hospital in scientific management of expenses.At the same time,it provides a reference for medical insurance agencies to implement DRG payment.Methods The DRG data of a third-level traditional Chinese medicine hospital and a third-level general hospital in a city in 2021 were extracted,there were 19578 cases in traditional Chinese medicine hospitals and 55701 cases in general hospitals,and DRG-related indicators were used for comparative analysis.Results Among the top 10 patient groups in the TCM hospital,one patient group had a weight(that is,the ratio of the past average cost of this patient group to the average cost of all local patient groups)>1.5,the cost consumption index had 3 patient groups>1,and the time consumption index there were 2 disease groups≥1,and the proportion of high magnification was 0.00%to 1.48%.In the general hospital,2 of the top 10 patient groups had a weight>1.5,two of the cost consumption index were>1,the time consumption index was<1,and the proportion of high magnification was 0.00%to 1.68%.The average CMI of the top 10 patient groups was 1.05 in both traditional Chinese medicine and general hospitals, the average cost consumption index was 0.94 in traditional Chinese medicine hospitals and 0.89 in general hospitals, and the average time consumption index of traditional Chinese medicine hospitals: 0.85, general hospitals: 0.68, high rate ratio of traditional Chinese medicine hospitals: 0.45%, general hospitals: 0.32%. Conclusion On the whole, the cost management of the top 10 patient groups in the two hospitals is better, and the efficiency of the general hospital is better than that of the traditional Chinese medicine hospital. The DRG tool can not only realize the payment function of medical insurance funds, but also effectively evaluate the medical efficiency and benefit level of each hospital, which is convenient for hospitals to manage their expenses. It also reminds medical insurance agencies to take into account the particularity of traditional Chinese medicine treatment in the implementation process to make DRG payment more reasonable and fair.
作者
罗民
刘美娥
李红霞
杨贵雷
张彩霞
LUO Min;LIU Mei'e;LI Hongxia;YANG Guilei;ZHANG Caixia(Department of Medical Insurance,Hezhou People's Hospital,Hezhou,Guangxi Zhuang Autonomous Region,542800 China)
出处
《中国卫生产业》
2022年第15期147-150,共4页
China Health Industry
基金
贺州市科学研究与技术开发计划项目(贺科技2021001)。
关键词
疾病诊断相关分组
DRG指标
效益
效率
Disease diagnosis-related grouping
DRG index
Benefit
Efficiency
