基于DRG收付费实施对白内障手术住院费用影响因素的探究

Research on Influencing Factors of Hospitalization Expenses of Cataract Surgery Based on DRG Payment

目的以福建省某三甲综合医院眼科白内障手术患者为例,对比扩大疾病诊断相关分组(diagnosis related groups,DRG)改革前后患者白内障手术住院费用的变化,探讨基于DRG在临床科室精细化管理中的应用路径,为推进医保支付制度改革提供依据。方法收集2021年1月—2022年1月福建省某三甲医院眼科患者出院记录,对DRG收付费实施前分组的组间比较采用Mann-Whitney U检验评价,对影响DRG收付费用的因素采用单因素分析后纳入多元线性回归模型,结果均以P<0.05为差异有统计学意义。结果对比DRG医保支付费实施前后病例,发现住院天数、按项目结算费用、两种结算方式差额、药品费、检查化验费、耗材费、手术费、医务性收入、麻醉科总费用差异有统计学意义(P<0.05)。根据标准化系数可见,耗材费、医务性收入是影响DRG支付金额主要因素。结论进一步完善DRG收付费管理工作,医院内部制定合理临床路径与成本管理体系,实现医院精细化管理。

Objective Taking cataract surgery patients in a 3A general hospital in Fujian Province as an example,this paper compares the changes of hospitalization expenses of cataract surgery patients before and after the reform of expanding diagnosis related groups(DRG),and discusses the application path of DRG in the fine management of clinical departments,so as to provide a basis for promoting the reform of medical insurance payment system.Methods The discharge records of ophthalmic patients in a 3A hospital in Fujian Province from January 2021 to January 2022 were collected.Mann-Whitney U test was used to evaluate the comparison of DRG payment before implementation,and the factors affecting DRG payment were analyzed by single factor and then incorporated into multiple linear regression model.The results were statistically significant(P<0.05).Results The cases before and after the implementation of DRG medical insurance payment were compared,it was found that there were significant differences in hospitalization days,project-based settlement fees,the difference between the two settlement methods,drug fees,examination and laboratory fees,consumables fees,operation fees,medical income and total expenses of anesthesiology department(P<0.05).According to the standardization coefficient,consumables and medical income are the main factors affecting the payment amount of DRG.Conclusion Further improve the management of DRG payment,establish a reasonable clinical pathway and cost management system within the hospital,and realize the fine management of the hospital.