DRG付费方式下公立医院结余分析与运营策略研究

Research on balance analysis and operation strategy of public hospitals under DRG payment method

目的:研究DRG付费方式下公立医院结余的结构及成因,探讨医院可持续发展的运营策略。方法:将住院产生的医院结余拆分成医疗结余和医保结余两部分,通过公式组合、推导,找到影响医院结余的关键因素。结果:形成医院结余的因素受医保机构结余留用政策影响,当医保结余全部归医院留用时,医疗成本是影响医院结余的唯一院方可控变量;当医保结余部分归医院留用时,医疗收入和医疗成本同为影响医院结余的院方可控变量。结论:在DRG付费方式下,公立医院应转变管理理念,加强智慧医院建设,通过推动精细化管理促进医疗收入的内涵式增长和医疗成本的合理管控,以获取适当结余,保障为人民提供公益性、高质量医疗服务的可持续性。

Objective:To study the structure and causes of public hospital balances under the DRG payment method and to explore the operation strategies for sustainable hospital development.Methods:Hospital balances generated from hospitalization were split into two parts:medical balances and health insurance balances,and the key factors affecting hospital balances were found by combining and deriving formulas.Result:The factors that shape hospital balance are influenced by the retention policy of health insurance institutions.When all of the health insurance balance is retained by the hospital,medical cost is the only hospital controllable variable that affects hospital balance;when part of the health insurance balance is retained by the hospital,medical revenue and medical cost are both hospital controllable variables that affect hospital balance.Conclusion:Under the DRG payment method,public hospitals should change their management philosophy,strengthen the construction of smart hospitals,and promote the internal growth of medical revenue and reasonable control of medical costs by promoting refined management in order to obtain appropriate balances and guarantee the sustainability of providing public welfare and high-quality medical services to the people.