DRGs付费下浙江省中医与西医医院住院费用分析——以剖宫产组(OB15)为例

Analysis of Hospitalization Expenses of DRG Group In Traditional Chinese Medicine Hos⁃pital And Obstetrics and Gynecology Hospital From Zhejiang Province:Take The Group of Cesarean Section As An Example

目的:分析某三甲中医院和妇产科专科医院OB15(剖宫产,无并发症或合并症)疾病诊断相关分组的住院费用,为DRGs费用支付及管控提供依据。方法:利用病案首页信息和结算清单,通过消耗指数对2020年两家医院符合入组标准的病例进行分析;对主要构成费用进行比较,探究两家医院的收费结构合理性。结果:从消耗指数方面分析,专科医院的住院时间和费用水平优于中医医院;从各类费用构成看,体现医务人员劳务价值的手术费(含麻醉)和治疗费两家医院大致相同,但是专科医院的药品费大幅高于中医医院,中医医院的检查费和床位费需要进行控制。结论:中医医院的激励机制需要细化,逐步向中医优势病组和危重症患者倾斜;优化医疗资源配置,提高医疗信息化水平,最终实现价值医保。

Objections:To analyze the hospitalization costs of patients without complication/comorbidities diagnosed by Cesarean in a certain grade A tertiary Chinese Medicine Hospital and Obstetrics and Gynecology Hospital then provide basis for DRGs paymentand management.Methods:Using the front page of medical records and the receipt to analysis the cases that met the inclusion criteria in the two hospitals in 2020 were analyzed,through the consumption index.Then compared the main cost composition to judge the rationality of the charging structureof the two hospitals.Results:In terms of the consumption index,Obstetrics and Gynecology hospital is bet⁃ter than Chinese medicine hospitalin length of hospital stay and cost levels,from various cost composition,the operating expense(in⁃cluding anesthesia)and treatment expense which reflect the value of doctors are much the same.However,the cost of medicines in Obstetrics and Gynecologyhospital is significantly higher than that in traditional Chinese medicine hospital.The Chinese medicine hospital should reduce inspection and bed costs.Conclusions:The incentive mechanism of traditional Chinese medicine hospitals needs to be refined,and gradually tilted towards the advantageous group of traditional Chinese medicine and critically ill patients.To optimize the allocation of medical resources,improve the level of medical informatization,and finally realize the value of medical insurance.