ERAS助力医保单病种控费

ERAS helps the department of general surgery controlling costs of the single-diseases in medical insurance

目的:通过基于DRGs和临床路径的方法控制单病种费用,未能完全实现目标,且出现了新的问题,亟需寻找新的方法。方法:2018年6月普外科引入加速康复外科(ERAS)理念和模式,最终实现了控费目的。本文通过分析2016—2019年普外科单病种例数、费用、住院时间、术后恢复时间等评估ERAS对单病种控费的影响。结果:2016—2019年单病种手术量持续增长,2018年超支例数下降,尤其7月以后下降显著。2016年至2018年6月单病种结算超支,2018年7月实现结余。结论:与传统方法相比,ERAS不仅能助力单病种控费,而且还能克服原有方法的缺陷,实现“多方共赢”。该经验值得进一步推广应用。

Objective:By controlling the cost of a single-disease based on DRGs and clinical pathways,the goal has not been fully achieved,and new problems have arisen,the new methods are urgently needed.Methods:In June 2018,the department of general surgery introduced the concept of accelerated rehabilitation surgery(ERAS),established a multidisciplinary collaboration team(MDT),promoted patient rehabilitation,and objectively achieved the purpose of control costs.This paper evaluates the impact of ERAS on single diseases control costs by analyzing the number of single cases,costs,hospitalization days in department of general surgery from 2016 to 2018.Results:The number of single-diseases increased continuously in 2016-2018,the number of over-quota cases decreased in 2018,especially after July.In 2016 and 2017,the costs exceeded the quota.They began to control costs from July 2018.Compared with January-June in 2018,July-December the average hospitalization days decreased significantly.Conclusion:Compared with the traditional methods,ERAS can not only help the single-diseases control costs,but also overcome the defects of the original methods and achieve"Multi-win-win".This experience deserves further promotion and application.