DRGs试点的住院费用控制效果分析与推行建议

An Analysis of the Effect of Hospitalization Expenses Control in DRGs Pilot and Implementation Recommendations

分析北京市2011年实施的DRGs对参保患者住院医疗费用的影响效果,为国家下一步开展按DRGs付费试点,探索建立DRGs付费体系提供参考。利用北京市2010年和2016年三甲公立医院阑尾切除手术参保患者住院病例数据,运用双重差分法计量回归模型比较了实施DRGs前后的参保患者住院医疗费用变化。结果显示,阑尾切除手术参保患者住院实际发生的医疗费用总额、药品费用、医保统筹基金支出金额和个人账户支出金额均显著减少。但是DRGs的实际控费效果依然不够理想,应在大力推行DRGs的同时,既要立足DRGs本身制定标准,使其更加科学合理、精准到位,也要从DRGs的外部条件入手,建立和完善与之适应的配套机制。

The effect of the implementation of DRGs in Beijing in 2011 on the inpatient medical expenses of insured patients is analyzed in this paper with reference for the country to carry out the pilot program of DRGs payment and an exploration of the establishment of DRGs payment system.Using the hospitalized case data of insured patients with appendicitis in Beijing Public Hospital in 2010 and 2016,the double difference method was used to compare the changes in hospitalization expenses of insured patients before and after the implementation of DRGs.The results showed that the total medical expenses incurred in hospitalization for patients with appendicitis resection,the cost of medicines,the amount of medical insurance pool funds and the amount of personal account expenditures were significantly reduced.However,the actual control effect of DRGs is still not ideal.At the same time,DRGs should be vigorously promoted,and the standards of DRGs should be established to make them more scientific,reasonable and accurate.It is also necessary to establish and improve the external conditions of DRGs with the supporting mechanism for adaptation.