DRG改革下某公立医院2021年第一季度住院费用分析

Analysis of inpatient medical expenses of a hospital in the first quarter of 2021 under the reform of DRG payment method

目的:回顾分析合肥市某公立医院2021年第一季度DRG付费实施后医院住院费用支出情况,探索存在的问题与解决途径,为公立医院精细化管理和高质量发展提供参考。方法:从医院医保系统获取本地医保患者住院费用分组数据,进行描述性统计与分析。结果:实施DRG付费后,医院第一季度费用总体超支,病种权重分布还待优化,科室临床诊疗行为尚待完善。结论:医院应重视目前实际付费阶段存在的问题,转变传统医保按项目付费观念,合理利用DRG评价指标,成立DRG研究小组,着力推动多部门协同联动,以更好适应DRG支付方式改革。

Objective:To review and analyze the Inpatient medical expenditure of a public hospital in Hefei after the implementation of DRG payment in the first quarter of 2021,explore the existing problems and solutions,and provide a reference for the fine management and high-quality development of public hospitals.Methods:The inpatient cost grouping data of medical insurance patients were obtained from the medical insurance system of the hospital,and descriptive statistics and analysis were carried out.Results:After the implementation of DRG payment,the overall cost overrun of the hospital in the first quarter,the weight distribution of diseases still needs to be optimized,and the clinical diagnosis and treatment behavior of the departments still needs to be improved.Conclusion:Hospitals should pay attention to the problems existing in the current actual payment stage,change the traditional concept of fee for service,make rational use of DRG evaluation indicators,the establishment of DRG research group,strive to promote multi-department collaboration and linkage,to better adapt to the reform of DRG medical insurance payment mode.