DRG支付下脑卒中患者住院费用控制研究

Research on the Control of Hospitalization Expenses of Stroke Patients in the Context of DRG Payment

目的:分析某三级医院脑卒中患者的住院费用和医保结算费用,为精细化控制住院费用提供参考。方法:选择2018—2019年的BR21病组病例,利用描述性分析方法、单因素分析和多元线性回归进行费用分析。结果:纳入研究的1381例病例,平均住院费用为11808.82元,2019年例均亏损77.34元;住院费用以检查费、药品费和检验费为主,患者的性别、入院途径、入院状态、住院天数和有无并发症是影响住院费用的主要因素。结论:医疗费用控制是医保支付方式改革的重点,要合理运用DRG实现整体控费,调整费用结构,推行临床路径管理以降低住院天数,同时建议医保部门动态调整医保定额标准,科学实现风险分摊。

Objective To analyze the hospitalization expenses and insurance reimbursement of stroke patients in a tertiary hospital,and to provide a reference for the fine control of hospitalization expenses.Methods This study selected the BR21 disease group cases from 2018 to 2019,and used descriptive analysis,single factor analysis and multiple linear regression for cost analysis.Results A total of 1381 cases were included in the study.The average hospitalization expenses was 11808.82 Yuan,and the hospital lost an average of 77.34 Yuan per case in 2019.The hospitalization expenses were mainly composed of cost of examination,cost of medicine,and cost of diagnostic test.Gender,admission route,admission condition,the number of hospitalization days,and with complications or not were main influencing factors of hospitalization expenditures.Conclusion Medical cost control is the focus of the reform of medical insurance payment.It is necessary to rationally use DRG to achieve overall cost control,adjust the cost structure,and implement clinical path management to reduce the number of hospitalization days.It is also recommended that the medical insurance department dynamically adjust the medical insurance quota standard and scientifically realize risk sharing.