基于两个病种的医疗费用控制路径分析

Exploring The Path Of Controlling Medical Expenses Based On Two Diseases

目的:本文通过分析佛山市某区医疗机构“短暂性脑缺血发作”和“缺血性脑卒中”住院医疗费用,寻找各医疗机构费用构成的差异性,为控制医疗费用过快增长提供精准化切入点。方法:分解医疗机构费用构成,和权威临床诊疗指南对照分析。结果:不同医疗机构诊疗同一疾病的费用构成存在明显差异性:部分医疗机构诊疗指南符合率低,需重点考虑是否存在轻病入院等;部分医疗机构药品费用占比高,需重点监控医院药品特别是辅助用药使用情况;部分医院检查费用占比高,需重点核查检查情况;部分医院理疗费用占比高,需重点核查理疗使用情况。结论:通过对医疗机构费用构成分析,可以为医保管理部门控制医疗费用提供精准方向,为医疗机构改善医疗质量提供切入点。

Purpose:This paper analyzes the Transient Ischemic Attack and Ischemic Stroke in medical institutions in a district of Foshan,looking for the differences in the cost composition of various medical institutions,so as to provide accurate entry point for controlling the rapid growth of medical expenses.Methods:By decomposing the cost structure of medical institutions and comparative analysis with authoritative clinical diagnosis and treatment guidelines.Results:It is found that the cost composition of different medical institutions in the diagnosis and treatment of the same disease is obviously diff erent.Some medical institutions have a low coincidence rate of diagnosis and treatment,and it is important to consider whether there is a admission to mild illness.Some hospitals have a high proportion of drug costs and need to focus on monitoring the use of drugs.Some hospitals have a high proportion of physiotherapy costs and need to check the use of physiotherapy.Some hospitals have a high proportion of inspection costs and need to focus on inspecting the checked situation.Conclusion:Through the analysis of the cost composition of medical institutions,it provides accurate directions for medical insurance management departments to control medical expenses,and provides an entry point for medical institutions to improve medical quality.