统筹支付下医保支付改革的实证分析

Empirical Analysis on the Reform of Medical Insurance Payment under the Over All Payment

目的通过对比黄石市中心医院医保支付改革前(2017年)与改革后(2018年)医保相关指标,评估以DRGs为基础的预付费(DRGs-PPS)应用效果。方法采用描述性统计方法对相关DRGs数据进行比较。结果改革施行后,整体指标改善明显。通过与2017年对比,2018年医保患者总额同期减少47017292.80元,均次费用平均下降3.62%,平均住院日平均下降6.15%,药占比平均下降22.48%,耗占比平均下降14.73%,出院人数增加9.77%,总权重增加13.99%,CMI增加3.85%。结论DRGs-PPS支付改革降低了医疗费用,调整了医疗结构,促进了医疗技术发展,也体现了医保支付方式有效引导医疗行为的作用,值得推行。

Objective To evaluate the effect of payment reform based on the diagnosis related groups and prospective payment system(DRGs-PPS)in Huangshi Central Hospital by comparing the related indicators before the reform in 2017 and after in 2018.Methods The data of DRGs were compared by descriptive statistical methods.Results After the implementation of reform,overall indicators were improved significantly.Compared with the whole year of 2017,the overall planning cost decreased by 47017292.80 Yuan in the same period in 2018,the average cost decreased by 3.62%,the average hospitalization day decreased by 6.15%,the average pharmacy proportion decreased by 22.48%,the average consumption proportion decreased by 14.73%,the number of discharged patients increased by 9.77%,the weight increased by 13.99%,and the CMI increased by 3.85%.Conclusion The DRGs-PPS payment reform reduced medical expenses,adjusted the medical structure,promoted the development of technology,and reflected the effect of medical insurance payment methods to effectively guide medical behavior,which is worthy of implementation.