C-DRG和DIP在公立医院控费效果的对比研究

Comparison of Cost Control Effect between C-DRG and DIP in Public Hospitals

目的 比较C-DRG和按病种分值付费(DIP)在公立医院控费效果的差异。方法 采用方便抽样的方法抽取福建省厦门市某三级甲等综合医院2020年1月1日—2022年2月28日出院的169 089例病例,根据医保支付方式的不同,将研究对象分为C-DRG组47 416例和DIP组121 673例,比较医疗机构诊疗行为和费用的差异。结果 在实施C-DRG后,平均总费用下降了9.2%,药品、材料、检查、检验和其他费用分别下降了10.0%、7.6%、11.9%、12.5%和7.4%,与DIP比较差异均有统计学意义(P<0.01)。采用多元线性回归分析校正各种混杂因素后,C-DRG的控费优势仍差异有统计学意义(P<0.01)。结论 C-DRG的控费效果较好,但试点城市仍较少,需进一步扩大试点验证。

Objective To compare the difference of C-DRG and DIP on fee control in public hospitals. Methods The convenience sampling method was used to select 169 089 cases discharged from a Class A tertiary general hospital in Fujian Province Xiamen city from Jan 1,2020 to Feb 28,2022. According to the different payment models of medical insurance,the subjects were divided into 47 416 cases in the C-DRG group and 121 673 cases in the DIP group. The differences of diagnosis and treatment behavior and expenses of medical institutions were compared by the combination of single factor and multi factor analysis. Results After the implementation of C-DRG,the average total cost decreased by 9.2%,and the costs of drugs,materials,inspection,inspection and other expenses decreased by 10.0%,7.6%,11.9%,12.5% and 7.4% respectively. Compared with DIP,the difference was statistically significant(P<0.01). After adjusting various confounding factors by multiple linear regression,the cost control advantage of C-DRG was still statistically significant(P<0.01). Conclusion The cost control effect of C-DRG is good,but there are still few pilot cities,which need to be further expanded for verification.