按病种分组付费对急性脑梗死影响费用分析

Analysis of the Influence of Paid by Diagnosis-Related Groups on Acute Cerebral Infarction

目的分析2013年-2017年北京市某三甲医院按病种分组付费对急性脑梗死病案费用的影响,探讨政策影响。方法对某医院2013年-2017年神经内科急性脑梗死出院病案,按照实施按病种分组,DRG付费组和非DRG付费组两组病案进行38项费用统计差异性分析。结果 2013年-2017年急性脑梗死出院病案6655例纳入分析,DRG付费组在总住院费用、西药费和治疗用一次性医疗材料费比非DRG付费组花费更少,差异具有统计学意义。DRG付费组比非DRG付费组每次住院费用少376元。同时,在调整了其他因素影响后发现急性脑梗死患者的住院费用每年增长764元,正常医嘱离院比医嘱转院要少2631元,每多住一天院需要多花费1426元。结论通过统计DRG政策两组住院总费用,住院时间是住院费用差异的因素,不同离院方式间住院费用存在差异,DRG付费组收治医嘱转院病例多住院时间长,但住院总费用低于非DRG付费组,DRG政策影响并未导致医疗服务提供者推诿重患者的情况,DRG付费政策控费效果明显。

Objective To analyze the impact of paying for a group of patients in a hospital in Beijing from 2013 to2017 on the cost of acute cerebral infarction and to explore the impact of policy. Methods A total of 38 cost statistical differences were analyzed for the outpatients of neurology in a hospital from 2013 to 2017 in accordance with the policy impact of the disease grouping and non-policy effects. Results In the period of 2013-2017, 6655 cases of acute cerebral infarction discharged from the hospital were included in the analysis. The DRG paid group spent more on total hospitalization expenses, western medicine fees, and disposable medical materials for treatment than the non-DRG payment group, with statistical differences. The DRG payment group costs 376 yuan less than the non-DRG payment group. At the same time, after adjusting for the influence of other factors, the hospitalization expenses of patients with acute cerebral infarction increased by 764 yuan per year. The normal doctor’s hospitalization was 2631 yuan less than the doctor’s transfer, and it cost 1426 yuan for each day. Conclusion Through the statistical DRG policy, the total cost of hospitalization in the two groups was statistically significant.The length of hospitalization was the difference in hospitalization expenses. There was a difference in hospitalization costs between different methods of hospitalization. The DRG policy affected group was hospitalized for a longer period of time. However, the total cost of hospitalization was lower than that of the non-DRG policy-affected group.The DRG policy impact did not lead to the situation of medical service providers pushing patients seriously. The DRG payment policy control effect was obvious.