中医优势病种在综合医院和中医类医院住院费用对比分析

Comparison of Hospitalization Expenses for TCM Dominant Diseases in General Hospitals and TCM Hospitals

目的:探究95个中医优势病种在综合医院和中医类医院(包括中医医院和中西医结合医院)的住院费用差异,为中医药医保支付方式改革提供数据参考。方法:收集2017—2019年47家医院的医保患者住院诊疗数据,根据ICD-10确定中医优势病种,统计中医优势病种在不同级别和类型医院中的总费用、住院天数和日均费用。结果:中医优势病种在综合医院的总费用高于中医医院、低于中西医结合医院,而住院天数低于中医类医院,日均费用高于中医类医院。中医优势病种的费用在不同类型、级别医院和不同病种之间存在差异。结论:由于医保支付方式对费用具有引导和控制的作用,建议在中医类医院施行DRG/DIP付费并且充分考虑医疗机构的实际情况。

Objective:To explore the differences in hospitalization expenses for 95 Traditional Chinese Medicine(TCM)dominant diseases between general hospitals and TCM hospitals,and to provide data references for the reform of TCM medical insurance payment methods.Methods:The inpatient diagnosis and treatment data of medical insurance patients in 47 hospitals from 2017 to 2019 are collected to determine TCM dominant diseases through ICD-10,and to calculate the total cost,length of stay and average daily cost in different levels and types of hospitals.Results:The total cost of TCM dominant diseases in general hospitals is higher than that of TCM hospitals and lower than that of hospitals of traditional Chinese and Western medicine(TCM-WH hospitals),while the length of stay is lower than that of TCM hospitals,and the average daily cost is higher than that of TCM hospitals.The cost of TCM dominant diseases varies among different types and levels of hospitals and different diseases.Conclusion:It is suggested that the actual situation of medical institutions should be fully considered when implementing DRG/DIP in TCM medical institutions,since the payment method of medical insurance plays a role in guiding and controlling the expenses.