疾病诊断相关分组实施对医用耗材供应管理的影响及对策研究

Research on the influence of DRG implementation on the supply management of medical consumables and countermeasures

目的:探讨疾病诊断相关分组(DRG)的实施对医用耗材供应管理的影响。方法:分析国家医疗保险支付中按服务项目付费、总额预付制、按服务单元付费、按人头付费和按病种收费5种方式的优缺点,研究DRG实施需综合考虑临床症状、人口统计、资源消耗及疾病严重等级等诸多变量,划分不同群组确定医保支付水平,从专业化采供人员、信息化管理手段、精细化监管机制和健全的采购运行模式4方面对医院耗材供应管理提出更高要求。结果:DRG实施需从建立医用耗材全生命周期管理机制、开展供应-管理-配送(SPD)托管服务、基于分类管理实现二级库精细化管理和医用耗材成本效益分析4个方面制定应对策略。实施耗材改革后,医院消化病中心整体患者例均费用下降11.3%,其中,耗材例均费用降幅20.8%,耗占比由43.6%降到33.6%。结论:DRG实施改变医院经济运营模式,必须在保证临床精准服务的基础上,加强医用耗材采购机制、集中配送、信息化平台建设和成本效益分析等方面研究,持续提高医院精细化管理水平。

Objective:To explore the influence of the implementation of diagnosis related groups(DRG)on the supply management of medical consumables.Methods:The advantages and disadvantages of five payment methods of national medical insurance,including payment based on service item,total prepayment system,payment based on service unit,payment based on capitation and payment based on disease type were analyzed.Clinical symptoms,demographics,resource consumption and severity of disease were considered in the study of DRG implementation,and different groups were divided to determine the level of medical insurance payment.Higher requirements were put forward for the supply management of medical consumables from four aspects:professional purchasing and supplying personnel,information management means,fine supervising mechanism and perfect purchasing operation mode.Results:For the implementation of the DRG,strategies were formulated from four perspectives:the establishment of a lifecycle management mechanism for medical consumables,the provision of supply-management-distribution(SPD)custody services,the realization of refined management of secondary pools based on classified management,and the costbenefit analysis of medical consumables.After the implementation of the reform of consumables,the overall average cost per patient in digestive disease center of the hospital decreased by 11.3%,of which,the cost per case of consumables decreased by 20.8%,and the consumption proportion decreased from 43.6%to 33.6%.Conclusion:The implementation of DRG to change the economic operation mode of hospitals must,on the basis of ensuring precise clinical services,strengthen the research on medical consumables procurement mechanism,centralized distribution,information platform construction and cost-benefit analysis,etc.,and continuously improve the level of hospital refinement management.