北京某“三甲”医院DRGs试点9225例盈亏分析

Analysis of profit and loss of 9225 cases of DRGs pilots of a third-grade class-A hospital in Beijing

目的探讨医院DRGs试点的盈亏情况及其原因。方法调查北京某"三甲"医院2011年12月至2013年12月参与105组DRGs试点的9225例出院病历的盈亏情况。结果 9 225例病历中基本医疗保险占96.50%,居民保险3.50%;盈利DRGs组78组(74.29%),亏损DRGs组27组(占25.71%);平均住院日9.37天,次均费用18 032.27元,次均定额标准17 337.53元,次均自费费用829.47元,次均自付二费用2 448.57元,次均盈利2 583.29元,次均自费自付二比例12.46%。盈利费用的对数与次均费用和平均住院日的对数呈负相关,与定额标准的对数和自费自付二比例呈正相关。结论当前DRGs试点模式医院整体盈利,对医院近期无显著影响。

Purpose To explore the profit and loss and the reasons of DRGs pilots of hospital. Methods The profit and loss of 9225 discharge cases participating in 105 groups of DRGs pilots of a third-grade class-A hospital in Beijing between December 2011 and December 2013 was investigated. Results Among 9225 cases, basic medical insurance accounted for 96.50%, and residents insurance accounted for 3.50%; 78 DRGs groups gained profit （74.29%）, and 27 DRGs groups suffered loss （25.71%）; the average day in hospital was 9.37, the average cost per time was 18,032.27 Yuan, the average quota standard per time was 17,337.53 Yuan, the average out-of-pocket cost per time was 829.47 Yuan, the average out-of-pocket cost 2 per time was 2,448.57 Yuan, the average profit per time was 2,583.29 Yuan, and the proportion of the average out-of-pocket cost 2 per time was 12.46%. The logarithm of profit cost was negatively correlated to the logarithm of the average cost per time and the average day in hospital, and positively correlated to the logarithm of quota standard and the ratio of out-of-pocket cost 2. Conclusion Using the current DRGs pilot model, the hospital gained profits, and it had no significant effect on the hospital in the near future.