北京地区剖宫产类似DRG分组研究

Research on DRG-like grouping of cesarean section patients in the Beijing area

目的建立北京地区剖宫产类似DRG分组模型,观察其控制医疗费用上涨的可行性。方法采用病例组合-DRG方法,对剖宫产进行类似DRG分组,根据合并症情况分为3组:严重合并症组、中度合并症组、轻或无合并症组。结果北京市剖宫产率维持在50%左右。经统计学处理,3组费用及住院时间差异有显著意义。严重合并症组70%的病例出现在高费用组,轻或无合并症组70%的病例出现在低费用组。结论控制剖宫产费用上涨的方法主要是降低剖宫产率,针对剖宫产的医疗保险、公费医疗付费模式考虑类似DRG分组的预定额支付方案。

Objective To establish a model of DRG-like grouping of cesarean section patients in the Beijing area so as to observe its feasibility of controlling rising medical costs. Methods DRG-like grouping of cesarean section patients was conducted by case-mix/DRG. The patients were divided into 3 groups according to complications： the serious complication group, the moderate complication group, and the minor or no complication group. Results The rate of cesarean sections remained at 50% or so in Beijing. A statistical analysis showed a significant difference between the 3 groups in costs and length of hospital stay. 70% of the cases in the serious complication group belonged to the high cost group whereas 70 % of the cases in the minor or no complication group belonged to the low cost group. Conclusion The main ways of controlling rising costs for cesarean sections include reducing the rate of cesarean sections and adopting DRG-like PPS payments in view of the nature of medical insurance and government payments for cesarean sections.