以血液学疾病为例按病种付费优势评估

Taking Hematological Diseases as an Example

目的分析比较采用按病种付费实施前后病种的平均住院费用、平均住院日和次均报销比例的差异,为下一步医保管理和支付方式改革工作提供建议。方法选取2018年1—10月在该院住院结算的弥漫大B细胞淋巴瘤(非初次化疗,非高危)、成人急性髓系白血病(非M3)巩固治疗和滤泡淋巴瘤(非初次化疗,非高危)3个病种的病例作为研究对象。比较采取按病种付费结算和按项目付费结算3个病种的平均住院费用、平均住院日和次均报销比例。结果按病种付费实施后,弥漫大B细胞淋巴瘤(非初次化疗,非高危)(t=16.55,P<0.001)、成人急性髓系白血病(非M3)巩固治疗(t=24.12,P<0.001)和滤泡淋巴瘤(非初次化疗,非高危)(t=13.01,P<0.001)3个病种次均报销比例均显著降低;成人急性髓系白血病(非M3)巩固治疗组平均住院费用显著减少(t=-2.21,P=0.028),弥漫大B细胞淋巴瘤(非初次化疗,非高危)组平均住院日显著缩短(t=-2.04,P=0.043)。结论与按项目付费相比,按病种付费展现出明显的优势。在今后的医保管理工作中,建议扩大病种覆盖范围,建立综合评价体系。

Objective To analyze and compare the differences in the average hospitalization expenses,average hospitalization days and sub-reimbursement ratios of disease types before and after the implementation of disease-based payment,and to provide suggestions for the next step of medical insurance management and payment method reform.Methods Patients with diffuse large B-cell lymphoma(non-primary chemotherapy,non-high risk),adult acute myeloid leukemia(non-M3)consolidation therapy and follicles were enrolled in our hospital from January to October 2018.Lymphoma(non-primary chemotherapy,non-high risk)cases of 3 diseases were studied.The average hospitalization expenses,average hospitalization days,and average reimbursement rates for the three types of disease-based billing and project-based billing were compared.Results After the implementation of the disease,diffuse large B-cell lymphoma(non-primary chemotherapy,non-high risk)(t=16.55,P<0.001),adult acute myeloid leukemia(non-M3)consolidation therapy(t=24.12,P<0.001)and follicular lymphoma(non-primary chemotherapy,non-high risk)(t=13.01,P<0.001),the reimbursement rate of the three cases was significantly reduced;the average hospitalization of adult acute myeloid leukemia(non-M3)consolidation treatment cost was significantly reduced(t=-2.21,P=0.028),and the mean hospitalization days were significantly shorter in the diffuse large B-cell lymphoma(non-primary chemotherapy,non-high-risk)group(t=-2.04,P=0.043).Conclusion Compared to paying by project,paying by disease shows a clear advantage.In the future medical insurance management work,it is recommended to expand the coverage of disease types and establish a comprehensive evaluation system.