病种分值结算政策对某中医医院医疗指标影响分析

Impact Analysis of Disease Entity Score and Settlement Policy to the Medical Indicators in a Traditional Chinese Medicine Hospital

目的分析某市病种分值结算政策实施对某三甲中医医院住院患者医疗指标影响情况。方法对2013年10月1日-2015年9月30日的出院患者数据运用描述性统计学方法和对比方法,分析病种分值结算政策实施前后各一年时间内住院患者各医疗指标的变化。结果病种分值结算政策实施后,出院患者数同比上升8.29%,病种数增长7.71%,平均住院日降低了0.52天,平均住院费用降低2.91%。职工医保出院患者数同比上升17.16%,病种数增长17.68%,平均住院日降低了0.97天,平均住院费用降低7.94%。职工医保顺位前20位病种中有分值的有18种,其中6个中医优势病种的出院人次4865,结算总费用同比降低48.46%。结论职工医保病种分值结算政策降低了平均住院日和平均费用,符合政策制定之目标。中医医院医疗机构等级系数低于同级西医院,中医优势病种结算分值普遍较低,对中医医院收入影响较大。?

Objectives To analyze the impact situations of disease entity score and settlement policy to the medical indicators of patients in a Class A and Tertiary Traditional Chinese Medicine Hospital. Methods To analyze the changes of the medical indicators of patients from October 1st, 2013 to September 30th, 2015 before and after the application of disease entity score and settlement policy with descriptive statistical method and compare method. Results After the disease score and settlement policy implementation, 8.29% rose in the number of the discharged patients, disease entities increased by 7.71%, the average length of stay reduced 0.52 days, average hospital cost reduced by 2.91%. The number of insurance for urban workers patient rose 17.16%, disease increased by 17.68%, the average length of stay reduced 0.97 days, the average hospital cost reduced by 7.94%. sorting before 20,there are 18 diseases in the disease score and settlement. And there were 4865 patients of the six advantages of traditional Chinese medicine disease, the total settlement cost reduced 48.46%. Conclusions The disease score and settlement policy reduced the average length of stay and average expenses, which was in accordance with the objective of the policy-making. But the grade coefficient of Traditional Chinese Medicine Hospital was lower than similar western hospitals, the score of advantage traditional Chinese medicine disease entity was generally low, which had relatively great influence on the Traditional Chinese Medicine hospitals.