公立医院基于DRGs及病案首页精准控费的实证研究——以骨科超支病种为例

Refined cost control of public hospitals based on DRGs and medical record homepage:an empirical study based on orthopedic overspending diseases

目的定位重点超支病种,分析超支原因及成本控制难点。方法以2016年1月1日—2020年12月31日某三甲公立医院骨科出院且进入DRGs分组的12721例患者为研究对象,共计234个DRGs病种,利用二八原则和波士顿矩阵定位重点超支病种。利用灰色关联分析和结构变动分析对其住院各项费用的关联度、结构占比及变动情况进行研究。结果定位骨科常见病种“IF15-上肢骨手术,不伴并发症与合并症”和难度较大的“IC13-大关节置换术,伴并发症与合并症”作为重点超支病种。IF15例均费用的关联度最大为耗材费,其次为治疗费和药费。IC13例均费用的关联度最大的为耗材费,其次为诊断费和药费。引起2个超支病种例均住院费用变动较大的有其他费用、耗材费、药费、治疗费和中医费。耗材费和药费对IF15和IC13例均费用结构变动的贡献率最大。结论样本医院骨科超支病种的耗材费、药费、诊断费管理仍需要加强。样本医院需要通过一系列措施,降低药品、耗材和诊断类的成本,进一步优化费用结构。

Objective To identify key overspending diseases and investigate the causes of overspending and the difficulties in cost control.Methods A total of 12721 patients who were discharged from the Department of Orthopedics in a public tertiary hospital from January 1,2016 to December 31,2020 and included in the DRGs grouping were selected as the research objects,with 234 diseases according to Diagnosis Related Groups(DRGs).The Pareto Principle and the Boston Matrix were used to identify the key overspending diseases.The relevance,structural proportion and changes of various hospitalization expenses were analyzed by using grey relational analysis and structural change analysis.Results The common orthopedic diseases like"IF15-upper limb bone surgery with or without complications"and"IC13-large joint replacement surgery with or without complications"were identified as key overspending diseases.The cost of consumables had the highest correlation with the IF15 cost per case,followed by the cost of treatments and medications.The cost of consumables had the highest correlation with the IC13 cost per case,but followed by the cost of diagnoses and medications.Others such as consumables costs,medication costs,treatment costs and traditional Chinese medicine costs contributed to the large changes in hospitalization costs for the two overspending diseases.Consumables and medications contributed to the largest extent to the changes in the fee structures of IF15 and IC13.Conclusion The management of consumables,medications,and diagnostics must be upgraded.The sample hospital needs to take a series of measures to optimize the cost structure and reduce the cost of medications,consumables and diagnostics.