摘要
目的分析疾病诊断相关分组(diagnosis related groups,DRG)高倍率病例费用结构,研究影响住院费用的相关因素,合理利用DRG评价指标,为公立医院精细化管理和高质量发展提供参考。方法以2021年1月—2022年6月广西某三甲医院为样本,描述分析高倍率病例特征,运用SPSS 26.0统计学分析各因素对费用的影响。结果数据来源为从医保平台选取2021年1月—2022年6月DRG终审数据,高倍率病例6217例,占比5.76%,内科组与外科组在高倍率病例占比比较,差异无统计学意义(P>0.05)。在单因素分析中,权重、科室类别对高倍率病例住院费用有显著影响(P<0.05),而医保类别与高倍率费用无关(P>0.05)。结论权重递增结合费用倍数递减的方式制定高倍率病例认定标准是相对科学合理的,但同时应加大对违规入组病例审核力度,重视目前实际付费阶段存在的问题,转变传统医保按项目付费观念,多种付费方式相结合,合理利用DRG评价指标,以更好适应DRG支付方式改革。
Objective To analyze the cost structure of cases with high rate of DRG,study the related factors affecting the hospitalization cost,and rationally use the evaluation index of DRG,so as to provide reference for the fine management and high-quality development of public hospitals.Methods A top-three hospital in Guangxi was taken as a sample to describe and analyze the characteristics of high-rate cases,and SPSS 26.0 was used to analyze the influence of various factors on the cost.Results The data source was the DRG final trial data from January 2021 to June 2022 selected from the medical insurance platform.There were 6217 cases with high rate,accounting for 5.76%.There was no significant difference in the proportion of high rate cases between the medical group and the surgical group(P>0.05).In the univariate analysis,the weight and department category had significant effects on the hospitalization cost of high rate cases(P<0.05),but the medical insurance category had no correlation with high rate costs(P>0.05).Conclusion It is relatively scientific and reasonable to formulate the identification criteria for high-rate cases by means of increasing weight and decreasing cost multiple,but at the same time,we should strengthen the review of illegal enrollment cases,pay attention to the problems existing in the current actual payment stage,change the traditional concept of payment by project,combine multiple payment methods,and rationally use DRG evaluation indicators to better adapt to the reform of DRG payment methods.
作者
胡春蓉
廖莉莉
HU Chunrong;LIAO Lili(Medical Insurance Office,the Fourth Affiliated Hospital of Guangxi Medical University/Liuzhou Worker′s Hospital,Liuzhou Guangxi 545005,China)
出处
《中国卫生标准管理》
2024年第5期49-53,共5页
China Health Standard Management
关键词
DRG
高倍率病例
医保
权重
影响因素
费用结构
DRG
high rate cases
medical insurance
weight
influencing factors
cost structure
