DRG点数付费对恶性肿瘤手术患者住院费用和住院天数的影响分析

Impact analysis of DRG point payment on hospitalization costs and days of surgery patients with malignant tumor

目的分析DRG点数法付费方式对恶性肿瘤手术患者次均住院费用及平均住院天数的影响,为优化医保支付制度提供参考。方法从宁波市医疗机构综合监管平台,选取2019年7月至2022年6月宁波市4家三级综合医院肺部、结直肠及甲状腺恶性肿瘤手术患者的病案首页数据,提取患者住院费用和住院天数信息;采用结构变动度和中断时间序列分析DRG点数法付费实施(2021年1月)后3种恶性肿瘤手术患者的次均住院费用、费用结构和平均住院天数的变化情况。结果共纳入39708例患者病案首页,其中肺部、结直肠及甲状腺恶性肿瘤手术患者分别为19635、6073和14000例。恶性肿瘤手术患者次均住院费用从DRG点数付费实施前的29662元增至实施后的30097元(P<0.05),平均住院天数从10.83 d降至9.42 d(P<0.05)。恶性肿瘤手术患者住院费用构成比最高的是耗材费(35.12%),其次为治疗费(23.52%)。DRG点数付费实施后,药品费构成比下降2.98%,综合医疗服务费、治疗费、检验检查费和耗材费构成比分别增加0.90%、0.23%、0.93%和0.92%;其中,药品费的结构变动度贡献率最大(50.13%),其次为检验检查费(15.59%)和耗材费(15.34%)。经中断时间序列分析,DRG点数法付费实施后,肺部恶性肿瘤患者次均住院费用呈缓慢增长趋势(P<0.05),其他2种恶性肿瘤患者次均住院费用涨势均有所放缓(P>0.05);3种恶性肿瘤手术患者平均住院天数下降趋势相对平缓(P>0.05)。结论DRG点数法付费实施后,宁波市4家医院恶性肿瘤手术患者次均住院费用整体增加,但涨势放缓,且费用结构得到一定优化;同时,患者平均住院天数得到缩短,变化趋势较平缓。建议在推行DRG点数法付费政策的同时,应重点加强检验检查项目和医用耗材的监管。

Objective To analyze the impact of disease diagnosis-related groups(DRG)point payment on average hospitalization costs and days of surgery patients with malignant tumors,so as to provide references for optimizing the policies of medical insurance payment.Methods The medical record homepage data of surgery patients with lung,colorectal,and thyroid malignant tumor in four tertiary comprehensive hospitals in Ningbo from July 2019 to June 2022 were selected from the comprehensive supervision platform of medical institutions,and the informations on patient hospitalization costs and length of stay were extracted.The structural variation and interruption time series analysis methods were used to analyze the changes in the average hospitalization costs,cost structure,and average hospitalization days of three types of malignant tumor surgery patients after the implementation of DRG point payment(January 2021).Results A total of 39708 patients were included in the medical records,including 19635,6073,and 14000 patients surgery with malignant tumors of the lungs,rectum,and thyroid,respectively.The average hospitalization cost for patients patients malignant tumor increased from 29662 yuan before the implementation of DRG point payment to 3097 yuan after implementation(P<0.05),and the average length of hospital stay decreased from 10.83 days to 9.42 days(P<0.05).The highest proportion of hospitalization costs for patients costs malignant tumor surgery was consumables expenses(35.12%),followed by treatment expenses(23.52%).After the implementation of DRG point payment,the proportion of drug expenses decreased by 2.98%,while the proportion of comprehensive medical service expenses,treatment expenses,inspection expenses,and consumables expenses increased by 0.90%,0.23%,0.93%,and 0.92%,respectively;Among them,the structural change contribution rate of drug expenses was the highest(50.13%),followed by inspection expenses(15.59%)and consumables expenses(15.34%).Through interruption time series analysis,it was found that after the implementation of DRG point payment method,the average hospitalization cost per visit of lung cancer patients showed a slow growth trend(P<0.05),but the growth trend of average hospitalization cost per visit of the other two types of patients slowed down(P>0.05);The average length of hospital stay for surgery patients of three types of malignant tumors showed a relatively flat downward trend(P>0.05).Conclusions After the implementation of the DRG point payment method,the average hospitalization costs for malignant tumor surgery in four hospitals in Ningbo had increased overall,but the upward trend had slowed down,and the cost structure had been optimized to a certain extent;At the same time,the average length of hospital stay for patients had been shortened,and the trend of change was relatively flat.It was recommended to strengthen the supervision of inspection items and medical consumables while implementing the DRG point based payment policy.