通过DRG数据指数化及标准化对住院费用细化分析与研究

Detailed Analysis And Research On Hospitalization Expenses Through Indexation And Standardization Of DRG Data

目的:结合疾病诊断相关分组(DRG)对沈阳市某三甲综合医院住院费用进行分析,为医院精细化管控住院费用及DRG权重设置提供参考依据。方法:利用沈阳市医保DRG平台系统,结合沈阳市KD19组(甲状腺大手术组)的平均住院日和例均费用,对该医院9个科室KD19组对应的各项指数进行比对分析,研究医疗服务效率能力的差异。对各科室该疾病组药品费用、耗材费用、医疗费用进行指数化处理,分析各项费用管控差异。再进一步将费用进行标准化处理,分析各项费用的离散情况。结果:9个科室的医疗服务效率能力总体较好,但均有一项或两项费用管理欠缺,其中3个总费用控制较好的科室中,有2个科室费用离散较大,存在拆补费用现象。结论:利用DRG标准化数据分析,可以指导医院对医疗服务效率能力进行管控。通过对医疗总费用进行拆分,评估各项费用消耗指数的离散情况,能够反映各科室费用控制的不均衡状况,为DRG实现精细化管理提供新的研究方向。

Objective:Combined with DRG,this paper analyzes the hospitalization expenses of a Grade III-A hospital in Shenyang,and provides reference for the hospital's refi ned control of hospitalization expenses and DRG weight setting.Methods:By using the DRG platform system of Shenyang healthcare insurance department,combined with the average length of stay and average case cost of KD19 group,the indexes of KD19 group in nine departments of the hospital were compared and analyzed to study the diff erence of medical service effi ciency.The drug costs,consumables costs and medical costs of the disease group in each department were exponentially processed,and the differences in cost control were analyzed.Then,the cost is standardized and the dispersion of each cost is analyzed.Results:The medical service effi ciency of the nine departments is generally good,but one or two of them are lack of cost management.Among the three departments with better total cost control,two departments have large discrete costs,and there is the phenomenon of split and supplement costs.Conclusion:Using DRG standardized data analysis can guide the hospital to control the effi ciency of medical services.By splitting the total medical expenses and evaluating the dispersion of each expense consumption index,it can refl ect the imbalance of each department's expense control,and provide a new research direction for refi ned management of DRG.