DRG IC39组“除置换/翻修外的关节手术”病例住院费用分析

Analysis on Hospitalization Expense of DRG IC 39 "Joint Surgery Except for Replacement/Revision Surgery"

目的:分析国家医疗保障疾病诊断相关分组(CHS-DRG) IC39组“除置换/翻修外的髋、肩、膝、肘、踝的关节手术”住院病例的费用特点及其影响因素,探讨控费措施及DRG分组优化策略。方法:以北京市样本三甲医院骨科CHS-DRG试运行IC39组的医保病例为研究对象,阐述不同特点病例的次均费用、费用构成,采用多重线性回归分析对住院总费用、耗材费用、检查治疗费用的影响因素进行分析。结果:耗材费用在IC39组关节手术病例的住院总费用中占比最高(81.24%),年龄、损伤部位、手术方式对住院总费用、耗材费用、检查治疗费用的影响均有统计学意义,损伤类型仅对检查治疗费用的影响有统计学意义。结论:耗材费用是IC39组的控费重点;对费用高、用量大的耗材可优先集采;关节重建修复手术操作复杂、费用高,宜单独成DRG组;陈旧损伤检查治疗费用高于新鲜损伤,但未能充分体现医务人员的劳动价值。

Objective:To analyze the expense characteristics and influence factors of inpatients in CHS-DRG group of IC39(joint surgery of hip,shoulder,knee,elbow and ankle except for replacement/revision surgery) and to explore expense control measures and grouping optimization strategies.Methods:The objects of this study from the patients with Beijing medical insurance who pilot IC39 group in a tertiary hospital featuring orthopedics in Beijing.The average expense and expense composition of objects with different characteristics were described.It conducted multivariate linear regression analysis to explore the influence factors of total hospitalization expenses,consumables expenses,and diagnosis expenses.Results:The consumables expenses in IC39 group accounted for the highest proportion of total hospitalization expenses(81.24%).Age,injury site and surgical method had statistically significant effects on total hospitalization expenses,consumables expenses,and diagnosis expenses.The type of injury only had a statistically significant effect on the diagnosis expenses.Conclusion:The consumables expenses were the key to control the expense of IC39 group.It gave priority to the centralized procurement of consumables with high price and large usage.The operation of joint repair and reconstruction,which should be formed in a DRG group separately,was more complicated and expensive.Diagnosis expense of old injuries was higher than that of fresh injuries,which was difficult to reflect the labor value of physician.