基于L市DRGs改革经验的医院费用变化模式分析

Analysis of hospital cost change model based on the experience of DRGs reform in L city

目的:从DRGs病组入手,比较贵州省L市实施新农合DRGs改革前后次均费用变化,分析试点医院在DRGs改革中的费用变化模式,为医院和医保部门加强管理提供参考。方法:从新农合基金管理平台提取L市实施DRGs付费制度的4所试点医院2016年1月〜2018年12月的住院医保数据,分析改革前后次均费用变化,根据其与支付标准的差距分析医院的费用变化模式。结果:三级医院中,42个DRGs组改革后次均费用下降,26个组差异有统计学意义;11个DRGs组改革后次均费用上升,3个组差异有统计学意义;二级医院中,16个DRGs组改革后次均费用下降,7个组差异有统计学意义;5个DRGs组改革后次均费用上升,变化均有统计学意义。结论:控费是试点医院改革后的主流费用变化模式,DRGs为医院和医保部门提供了费用管理与监管的参照系。既往费用的支付方式和支付标准以及医院对政府行为的远期预期均会影响DRGs病组费用的变化。改革需要关注重点病组的长期变化趋势。

Objective:This study starts with the DRGs groups,compares the changes of the average cost before and after the implementation of the NCMS DRGs reform in L city,Guizhou Province,and analyzes the cost change patterns of the pilot hospitals in the DRGs reform,so as to provide methods for hospitals and medical insurance departments to strengthen the management after the reform.Methods:We extract the medical insurance data of four pilot hospitals in L city from January 2016 to December 2018 from the new rural cooperative fund management platform and analyze the changes of the average cost of the disease groups before and after the reform.And we analyze the cost change model of the hospital according to the gap between the average cost and the payment standards.Results:In the tertiary hospitals,the average cost of 42 DRGs groups decreases after the reform,26 of them are statistically significant,and the average cost of 11 DRGs groups increases after the reform,3 of them are statistically significant.In the secondary hospitals,the average cost of 16 DRGs groups decreases after the reform,7 of them are statistically significant,and the average cost of 5 DRGs groups increases after the reform and the changes are statistically significant.Conclusions:Cost control is the mainstream cost change pattern after the reform of pilot hospitals.DRGs provide a frame of reference for cost management and supervision for hospitals and medical insurance departments.The way and standards of payment of previous costs and the long-term expectation of government behavior of the hospital will affect the change of the cost of DRGs groups.The reform should pay attention to the long-term change trend of key groups.