按疾病诊断相关分组付费实施效果——基于沈阳市某三甲医院

Implementation effect of payment according to disease diagnosis-related groups--based on a tertiary hospital in Shenyang

目的分析疾病诊断相关分组付费(DRGs)的实施效果,探讨更好实施DRGs的途径。方法选取沈阳市某三甲医院2020、2021年上半年全部出院患者为研究对象。对全部出院患者实行DRGs前后的各指标进行统计核算与分析,通过相对权重及病例组合指标方法,分析实行DRGs前后医院产能、效能等方面存在的差异及变化。结果实行DRGs政策的前后对比,医院的效能得到了提高,平均住院天数同期下降了3.58天。住院费用同期下降了4118.82元。2020、2021年上半年药占比分别为38.16%、34.15%,同期下降了4.01%。医院效能得到了提高;2020年降低1.52%,2021年降低2.13%,同期上升了0.51%,医疗安全得到了提升。2020、2021 DRGs权重分别为12300和11500,相对权重有所下降,病例组合指标有所提升。结论实施DRGs医疗资源消耗支出有所下降,医疗机构诊疗积极性有所提高,控制医疗保险成本上升的同时,提高了医疗服务质量,减少了患者的住院费用。

Objective To explore the implementation status,problems and countermeasures of DRGs.Methods All patients discharged from a grade A hospital in Shenyang in 2020 and the first half of 2021 were selected as the research objects.Cost accounting was conducted for all indicators of discharged patients before and after DRGs implementation,and problems existing in hospital capacity,efficiency and medical safety after DRGs implementation were analyzed by means of relative weight and case combination index method,and solutions were proposed.Results Before and after the implementation of DRGs policy,hospital efficiency was improved,and the average length of stay decreased by 3.58 days during the same period.Hospitalization costs decreased by MYM 4118.82 during the same period.The proportion of drugs in the first half of 2020 and 2021 was 38.16% and 34.15%,respectively,decreasing by 4.01% in the same period.Hospital efficiency has been improved,decreasing by 1.52% in 2020 and 2.13% in 2021,and increasing by 0.51% in the same period.Medical safety has been improved.The weights of DRGs in 2020 and 2021 were 12300 and 11500,respectively,with a decrease in relative weights and an increase in case portfolio indicators.Conclusion Through the study of DRGs problems and countermeasures,it can make up for the consumption of medical resources paid,improve the enthusiasm of medical institutions,control the rise of medical insurance cost,improve the quality of medical service,and reduce the consumption of hospital resources and hospitalization costs of patients.