摘要
目的分析DRG支付方式改革(以下简称DRG改革)对某专科医院肺癌手术患者住院天数、住院费用和手术并发症发病率的影响,为完善我国医保支付方式提供参考。方法从天津市某肿瘤专科医院电子病历系统提取2021年10月至2022年11月的肺癌手术患者病案首页数据,2021年11月该院启动DRG改革。将非天津市基本医疗保险参保患者作为对照组,天津市基本医疗保险参保患者为研究组,并根据DRG改革前后,将患者分为DRG改革前对照组、DRG改革前研究组、DRG改革后对照组和DRG改革后研究组。采用倾向得分匹配控制各组患者人口学特征差异,采用双重差分模型分析DRG改革对肺癌手术患者住院天数、住院费用和手术并发症发病率的影响。结果共纳入7689例肺癌手术患者,经倾向得分匹配后,DRG改革前对照组361例、DRG改革前研究组364例、DRG改革后对照组361例、DRG改革后研究组364例,共1450例患者。经双重差分模型分析,与DRG改革前相比,DRG改革后肺癌患者住院天数和住院费用分别降低了11.3%和4.8%,差异有统计学意义(P<0.05);其中,住院费用中的检查费用和耗材费用分别降低了7.1%和10.0%,差异有统计学意义(P<0.05),但手术费用、治疗费用和药品费用变化不明显(P>0.05);患者并发症发病率未见明显变化(P>0.05)。结论DRG支付方式改革能够降低肺癌手术患者住院天数和住院费用、保障患者医疗质量,但对住院费用结构的优化作用有待加强。
Objective To evaluate the impact of diagnosis-related group(DRG)payment reform on the hospitalization days,costs,and incidence of surgical complications of lung cancer surgery patients in a certain specialized hospital,so as to provide references for improving the medical insurance payment methods in China.Methods The data of lung cancer surgery patients′medical records were extracted from the electronic medical record system of a tumor specialized hospital in Tianjin City from October 2021 to November 2022.In November 2021,the hospital launched DRG reform.Non-basic medical insurance patients in Tianjin were selected as the control group,while patients with basic medical insurance in Tianjin were selected as the research group.Patients were divided into the control group before DRG reform,the research group before DRG reform,the control group after DRG reform,and the research group after DRG reform.The propensity score matching was used to control the demographic characteristics of patients in each group,and the different-in-difference model(DID)was used to analyze the impact of DRG reform on the hospitalization days,costs and incidence rate of surgical complications of lung cancer patients.Results A total of 7689 lung cancer surgical patients were included.After propensity score matching,there were 361 cases in the control group before DRG reform,364 cases in the research group before DRG reform,361 cases in the control group after DRG reform,and 364 cases in the research group after DRG reform.According to the DID analysis,compared with before the DRG reform,the hospitalization days and costs of lung cancer patients decreased by 11.3%and 4.8%after the DRG reform,respectively,with statistically significant differences(P<0.05);Among them,the examination cost and consumables cost in the hospitalization costs decreased by 7.1%and 10.0%respectively,with statistical significance(P<0.05),but the changes in surgical cost,treatment cost,and drug cost were not significant(P>0.05),as while as the incidence rate of complications(P>0.05).Conclusions The reform of DRG payment could reduce the hospitalization days and costs for lung cancer surgical patients,and ensure the quality of medical care for patients.However,the optimization effect on the hospitalization cost structure needed to be strengthened.
作者
高天夫
王洪涛
陈斌斌
Gao Tianfu;Wang Hongtao;Chen Binbin(Medical Record Department,Tianjin Medical University Cancer Institute and Hospital,National Clinical Research Center of Cancer,Tianjin′s Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy,Tianjin 300060,China;Beijing Medical and Health Economic Research Association,Beijing 100101,China)
出处
《中华医院管理杂志》
CSCD
北大核心
2024年第3期201-206,共6页
Chinese Journal of Hospital Administration
基金
天津市医学重点学科(专科)建设项目(TJYXZDXK-009A)
天津医科大学肿瘤医院引进人才与博士启动基金(B2312)。
关键词
疾病诊断相关分组
支付方式改革
肺癌
倾向得分匹配
双重差分模型
医疗保险
Diagnosis-related groups
Payment reform
Lung cancer
Propensity score matching
Difference-in-difference model
Medical insurance
