北京某院DRGs收付费模拟运行效果评价

Evaluation of DRGs Charging and Payment Simulation Operation Effect in A Hospital in Beijing

目的以TR医院为例,评估北京市DRGs收付费政策模拟运行两个月的效果。方法通过一个准实验方案,以模拟运行为控制因素,收集2017年12月-2018年1月(模拟运行前)和2018年12月-2019年1月(模拟运行后)时间段的相关医疗指标,从病组变化、服务能力、服务效率和医疗质量四个层面结合相关统计学方法进行前后侧对比。结果重点学科覆盖病组数改革后增加了7个(P<0.05),但全院总体病组数无变化;服务量和诊疗难度有所提升;平均住院日等多个效率指标较改革前均有显著改善(P<0.05);医疗质量指标较改革前无统计学差异(P>0.05)。结论目前,DRGs收付费在该院的模拟运行效果主要体现在服务能力和效率上,刺激相关流程的改善,同时保证了医疗质量,但控费效果不显著。建议在充分论证的基础上,正式推行DRGs收付费改革,关注结算等待时间的影响、病理医师人力资源配备、政策间衔接等问题。远期来看,DRGs收付费改革可发挥多方面积极作用,有助于保障群众基本医疗权益和医保制度长期可持续发展。

Objective Taking TR hospital as an example,the study evaluated and analyzed the effect of the simulated operation of DRGs charging and payment policy in Beijing for two months.Methods Through a quasi-experimental program and taking simulation operation as the control factor,relevant medical indicators in the period of December 2017 to January 2018(before the simulation)and December 2018 to January 2019(after the simulation)were collected,and the before-after comparison was made from the perspectives of disease group changes,service ability,service efficiency and medical quality by combining relevant statistical methods.Results The number of key clinical subject coverage groups increased by 7(P<0.05),but the total number of disease groups in the hospital did not change;the service volume and the difficulty of diagnosis and treatment increased;the average length of stay and other efficiency indicators were significantly improved than those before the reform(P<0.05);and there was no statistical difference on the medical quality indicators(P>0.05).Conclusion At present,the effect of DRGs charging and paying simulation operation in the hospital was mainly reflected in the service capacity and efficiency,which stimulated the improvement of related processes and guaranteed the medical quality,but the effect of cost control was not significant.It was suggested that,on the basis of full demonstration,the DRGs charging and payment reform should be formally implemented,with a focus on the impact of settlement waiting time,pathologist human resource allocation,and policy convergence,etc.In the long run,DRGs charging and payment reform can play a positive role in many aspects,and help protect the basic medical rights and interests of the general public and the long-term sustainable development of the medical insurance system.