摘要
目的:分析DRG支付方式下,包括高倍率病例和低倍率病例在内的特殊病例费用特征及其影响因素,为降低医疗费用、减轻患者负担和完善DRG支付方式改革提供参考。方法:选取某三甲综合医院2022年全年所有特殊病例的病案首页数据,采用描述性分析和单因素分析对特殊病例的影响因素进行分析,并通过结构方程模型分析各影响因素间的作用路径和影响程度。结果:纳入高倍率病例1281例(占总病例2.78%),其中治疗费用花费最多(占16.29%),费用最少的是诊察费(占0.79%);低倍率病例3266例(占7.09%),其中手术费用花费最多(占31.51%),费用最少的是诊疗费(占1.61%)。性别、年龄、住院天数、科室类别、医保付费方式、并发症均是特殊病例住院费用的影响因素(P<0.05)。结构方程模型结果显示,科室类别对费用的影响最大,性别对费用的影响最小。结论:调整医疗费用结构,缩短患者的住院天数,合理使用DRG支付方式,从而降低医疗费用、提高诊疗效率,实现总体控费目标。
Objective:To analyze the cost characteristics and influencing factors of special cases,including high-multiplier and low-multiplier cases,under the DRG payment system,providing references for reducing medical costs,alleviating patient burden,and improving DRG payment reform.Method:Data from the first pages of medical records of all special cases in a Grade III comprehensive hospital in 2022 were selected.Descriptive and univariate analyses were used to analyze the influencing factors of special cases,and a structural equation model was used to analyze the pathways and impact of these factors.Results:1,281 high-multiplier cases(2.78%of total cases)were included,with the highest expenses in treatment(16.29%),and the lowest in consultation fees(0.79%);3,266 low-multiplier cases(7.09%)were included,with the highest expenses in surgery(31.51%),and the lowest in diagnostic and therapeutic fees(1.61%).Gender,age,length of hospital stay,department type,insurance payment method,and complications were all factors influencing the cost of hospitalization for special cases(P<0.05).Structural equation model results showed that department type had the greatest impact on costs,while gender had the least.Conclusion:Adjusting the structure of medical expenses,shortening the length of hospital stay,and rational use of the DRG payment method can reduce medical costs,improve diagnostic and therapeutic efficiency,and achieve overall cost control goals.
作者
方秀斌
周典
田帝
周苑
吴烨
王浩宇
刘瑶瑶
吕曼辰
张钰
薛同斌
刘雪珍
FANG Xiubin;ZHOU Dian;TIAN Di;ZHOU Yuan;WU Ye;WANG Haoyu;LIU Yaoyao;LV Manchen;ZHANG Yu;XUE Tongbin;LIU Xuezheng(The Second Affiliated Hospital of Anhui Medical University,Hefei,Anhui Province,230601,PRC)
出处
《中国医院》
北大核心
2024年第6期53-56,共4页
Chinese Hospitals
基金
安徽省卫生健康委重点科研项目(AHWJ2021a022)
安徽省重点研发计划高新领域项目(202304a05020071)
安徽省高校协同创新项目(GXXT-2022-058)
安徽省高等学校科学研究项目(2022AH040158)
安徽医科大学医院管理研究所开放项目(2022gykj06)
安徽医科大学医院管理研究所开放项目(2023gYkJ01)
国家卫健委医院管理所研究项目(YLZLXZ22K001)。
关键词
疾病诊断相关分组
公立医院
高倍率病例
低倍率病例
住院费用
disease diagnosis-related groups
public hospital
high-multiplier cases
low-multiplier cases
hospitalization costs
