产科疾病按病种付费研究

Study on of DRGs-based payment system of maternity diseases

目的:以现场调查为基础,测算产科常见疾病医疗费用的平均水平及参考值范围,探索住院费用的影响因素。方法:以沧州市8所医疗机构的300名产妇的医疗费用为研究对象,利用中位数和P25和P75测算出医疗费用的平均水平、参考值范围,利用秩和检验、秩相关和逐步回归分析探索住院费用的影响因素。结果:将各种疾病医疗费用的P75作为费用控制上限;药品费用比重低于国家控制上限;年龄、住院天数、诊断个数、入院时情况等是影响住院费用的关键因素。结论:采取必要的措施降低住院天数和术前住院天数,完善病案的质量管理。

Objective： To estimate median and reference value range of medical expense for maternity diseases, and explore their affecting factors, and give Cangzhou city government some policy evidences to carry out DRGs - based payment system. Methods： After field survey on medical expense of 300 inpatients from 8 hospitals in Cangzhou city, average level and reference value range of medical expense were givein by means of median, P25 and P75. In addition, affecting factors of each disease through Kruskal Wallis H were calculated to analyze by spearman correlation coefficient and progressive regression. Results： P75 of medical expense of each disease was considered as upper control limit. Cangzhou city had lower than upper control limit by China government in proportion of drug expense. Key factors affecting medical expense were age, hospitalization days, number of diagnosis, disease status, and so on. Conclusion： Essential measures should be taken to reduce hospitalization days and days before sugery. Medical record management system should be improved.