攀枝花市实施DRGs付费改革对医保患者住院费用的影响分析

Effect of DRGs payment reform on hospitalization costs of medical insurance patients in panzhihua city

目的对攀枝花市某三甲医院医保患者的住院费用、费用结构等在实施按疾病诊断相关分组(DRGs)付费改革前后进行分析研究,评价DRGs付费改革试点效果,为医院实施DRGs费用精细化管理提供决策依据。方法采用回顾性研究方法,以某三甲医院2018年2-10月及2019年2-10月出院的医保患者病历进行多维度比较分析。采用SPSS22.0统计软件进行数据整理与分析。结果总体来看,DRGs实施前后除手术费有所提高外,住院时间、总费用及费用主要构成项目均有所下降,其中平均住院时间由10.66 d缩短至8.78 d,缩短17.64%;次均费用由10950.66元下降至8657.97元,下降20.94%;次均药费由3647.09元下降至2528.84元,下降30.66%。选取的十个常见病种中,DRGs实施后住院时间均有所减少(P<0.05);住院总费用中除肺炎外,其余病种均有所降低(P<0.05);药品费中除肺炎外,其余病种均有所降低(P<0.05);手术费用方面,多发性结肠息肉和肾积水伴输尿管结石DRGs实施前后手术费无明显变化(P>0.05),不稳定型心绞痛和冠心病手术费在DRGs实施后高于实施前(P<0.05)。结论攀枝花市DRGs付费改革的实施已初见成效,有利于控制医保患者住院费用的不合理增长,有利于减轻患者经济负担,保证医保资金安全运行,提高医院运营效率,不断调整优化费用结构,提升医院费用精细化管控水平。

Objective To analyze the hospitalization costs and cost structure of the medical insurance of the patients in a hospital in Panzhihua City before and after the implementation of DRGs payment reform,and evaluate the pilot effect of the DRGs payment reform,so as to provide a decision-making basis for the implementation of DRGs cost fine management in the hospital.Methods A retrospective research method was used to conduct a multi-dimensional comparative analysis of medical insurance patient discharged from February-October 2018 and February-October 2019 in a tertiary hospital.SPSS22.0 statistical software was used for data collation and analysis.Results Overall,before and after the implementation of the DRGs,except for the increase in the surgical costs among surgical patients,the number of hospital days,total costs and the main components of costs all decreased.The average length of hospital stay was shortened from 10.66 days to 8.78 days,shortened by 17.64%.And the per-time average cost decreased from RMB 10950.66 to RMB 8657.97,decreased by 20.94%.The per-time average drug cost decreased from RMB 3647.09 to RMB 2528.84,decreased by 30.66%.Among the ten common diseases selected,the days of hospitalization decreased after theimplementation of the DRGs(P<0.05);The total cost of the hospitalization decreased except that of the pneumonia(P<0.05),and the cost of medicine decreased except that of the pneumonia(P<0.05).In terms of the operation cost,there was no significant change in the operation cost before and after the multiple colonic polyps and hydronephrosis with the ureteral calculi(P>0.05),but the operation costs of the unstable angina pectoris and coronary heart disease were higher after DRGs than that of before(P<0.05).Conclusion The implementation of the DRGs payment reform in Panzhihua City has achieved initial results,which is beneficial to controlling the unreasonable growth of hospitalization costs for the medical insurance patients,reducing the financial burden of patients,contributing to the security of medical insurance funds,improving the operational efficiency of hospitals,continuously adjusting and optimizing the cost structure,and enhancing the level of fine control of hospital costs.