基于DRG分组的肿瘤患者住院费用影响因素

Hospitalization Expenses Control of Cancer Patients Categorized by DRG

目的 分析肿瘤患者住院费用超出DRG组例均费用的影响因素,探讨控费策略,为公立医院适应DRG支付方式改革,提高医院运行效益提供参考。方法 基于某三甲医院2019年1月1日-2020年11月30日8960例住院费用超过相应DRG组例均费用肿瘤患者的住院病案首页费用数据,采用多元回归方法进行住院费用的影响因素分析。结果 费用超出例均费用的患者多为放射治疗(RC19组)、化学治疗(RE19组)和手术患者(GB23组),例均住院费用分别为145 369.76元、23 121.20元、88 062.18元,分别超出所属DRG组例均费用57 817.85元、9798.81元、29 821.26元。DRG数据中医疗费用、药品费用、医技费用、耗材费用是住院费用差值形成的主要影响因素,进一步分析住院病案首页38项费用,结果提示手术费、物理临床治疗费、病理费、化验费、西药费、白蛋白类制品费、手术用一次性医疗材料费、治疗用一次性医疗材料费、介入用一次性医疗材料费等影响程度较大(P<0.05)。结论 对各DRG组进行例均费用分析可作为医院保障运营效益的重要参考,发现经济运行中的风险因素。同时DRG付费带来更多的是运营动力,医院需要制定合理、严谨的诊疗路径,提高诊疗服务效率,提升成本管控能力,改变医疗服务行为是医院控费的根本举措。

Objectives This study aims to analyze the interfering factors of cancer patients’ hospitalization expenses exceeding the average cost of the DRG group, to explore the strategy of cost control and to provide reference for public hospitals to adapt to the DRG payment method reform and improve the efficiency of hospital operation. Methods Based on the expense data on the front pages of inpatient medical records of 8960 tumor patients whose hospitalization expenses exceeded the average cost of the corresponding DRG group from January 1, 2019 to November 30, 2020, this study used multiple regression to analyze the interfering factors of hospitalization expenses. Results The patients whose expenses exceeded the average cost were mostly radiotherapy(RC19 group),chemotherapy(RE19 group) and surgery patients(GB23 group). The average hospitalization costs were 145 369.76yuan, 23 121.20 yuan, and 88 062.18 yuan respectively, which exceeded the average cost of the DRG group by 57 817.85 yuan, 9798.81 yuan, and 29 821.26 yuan respectively. According to DRG data, medical expenses,drug expenses, medical technology expenses, and consumables expenses were the main factors that lead to the difference in hospitalization expenses. Further analysis of the 38 expenses on the front pages of the inpatient medical records indicated that the expenses for surgery, physical clinical treatment, pathology, laboratory tests, Western medicine, albumin products, and disposable medical materials for surgery, treatment and intervention had a greater degree of influence(P<0.05). Conclusions The analysis of the average cost per case for each DRG group can be used as an important reference for hospitals to ensure operational benefits and to effectively find risk factors in economic operation. Moreover, DRG payment brings operational motivation. Hospitals need to formulate reasonable and rigorous diagnosis and treatment. The fundamental measures for hospitals to control cost are to improve the efficiency of diagnosis and treatment services, enhance the cost control capability and change medical service behaviors.