基于病种组分析医耗联动综合改革对大血管疾病住院费用的影响

Analyze the impact of comprehensive reform of medical expenditure linkage on the hospitalization expenses of macrovascular diseases based on the disease group

目的:运用DRGs的病种组分析医耗联动综合改革对大血管疾病住院费用的影响。方法:采用对比分析法,对某医院在医耗联动综合改革前(2018年7~12月)和改革后(2019年7~12月)大血管疾病的DRG数据进行分析。比较改革前后大血管疾病总体以及各病种组的住院费用变化情况。结果:大血管疾病总体住院费用改革前后变化差异没有统计学意义(P>0.05),其中医疗费用、管理费用、药品费用的变化差异有统计学意义(P<0.05)。主动脉手术、大血管外科三级手术和一级手术3个病种组的医疗费用、医技费用、管理费用均有不同程度的增长,药品、耗材费用下降,其中外科三级手术的医用耗材费用变化差异有统计学意义。医用耗材费用中主动脉手术组以介入耗材消耗为主,大血管外科三级手术组以手术耗材为主,大血管外科一级手术组以手术用和治疗用一次性耗材为主。各组不同的医用耗材费用变化也不同。结论:大血管疾病住院费用结构调整实现了医改目标,其中权重越高的手术病种组受本次医改政策的影响越大。建议医院可结合各病种组医用耗材使用的重点环节实施耗材管理,并继续配合推进医疗服务价格动态调整。

Objective:The effect of the comprehensive reform of combined medical consumption on hospitalization cost of great vessel surgery was analyzed by using DRGs disease group.Methods:A comparative analysis method was used to analyze THE DRG data of great vascular diseases in a hospital before and after the comprehensive reform of medical consumption linkage(July-December 2018)and(July-December 2019).The changes of hospitalization expenses of each disease group were compared before and after the reform.Results:There was no statistically significant difference in the overall hospitalization cost of great vascular disease before and after the reform(P>,0.05),among which the changes in medical expenses,administrative expenses and drug costs were statistically significant(P<0.05).The medical expenses,medical technology expenses and administrative expenses of the three disease groups of aortic surgery,tertiary surgery of great vascular surgery and primary surgery all increased to different degrees,and the costs of drugs and consumables decreased.Among them,the changes of medical consumables expenses of tertiary surgery were statistically significant.In the cost of medical consumables,the main consumption of interventional consumables was in the aortic surgery group.Surgical consumables were mainly used in the major vascular surgery group.The primary operation group of great vascular surgery mainly used disposable consumables for operation and treatment.Each group of different medical consumables cost changes is also different.Conclusions:The adjustment of hospitalization cost structure of great vascular disease has achieved the goal of medical reform,among which the higher the weight of the surgical disease group,the greater the impact of the medical reform policy.It is suggested that the hospital can carry out consumable management in combination with the key link of medical consumable use in each disease group,and continue to cooperate with and promote the dynamic adjustment of medical service price.