CHS-DRG支付改革对医院运行的影响分析

Analysis of the Impact of CHS-DRG Payment Reform on Hospital Operation

目的:分析CHS-DRG改革对试点医院运行的影响。方法:收集试点地区2017—2019年医院运行数据,对改革前后数据进行对比,通过重复测量方差分析和配对t检验分析指标的趋势变化。结果:CHS-DRG支付改革后,试点医院的住院患者平均住院日降低、人均住院费用无明显增长、人均药品费用下降,医务人员劳务费用占比增加、百元医疗收入消耗的卫生材料费用下降,时间消耗指数和费用消耗指数明显下降,医院DRG组数扩展、临床路径进一步规范、CMI值提升、死亡率下降。结论:CHS-DRG支付改革促进了医疗资源消耗的降低和医疗服务能力的提升;二级医院的医疗行为改变落后于三级医院;加强门诊费用控制是落实CHS-DRG支付政策的关键。

Objective To analyze the impact of CHS-DRG reform on the operation of pilot hospitals.Methods This study collected hospital operation data from 2017 to 2019 in the pilot areas to compare the results before and after the reform.Repeated measures analysis of variance and paired t test were used to analyze the trend changes.Results After the CHS-DRG payment reform,the average length of hospital stay decreased,the per capita hospitalization cost did not increase significantly,the per capita drug cost decreased,the proportion of medical staff services income increased,the cost of health materials consumed by 100 yuan of medical income decreased,the time consumption index and cost consumption index decreased significantly,the number of DRG groups was expanded,the clinical pathway was further standardized,the CMI value increased,and the mortality rate decreased.Conclusion CHS-DRG payment reform helped the reduction of medical resource consumption and the improvement of medical service ability.However,the change of medical behavior in secondary hospitals lags behind that of tertiary hospitals.And strengthening the control of outpatient expenses is the key to implementing the CHS-DRG payment policy.