摘要
目的:寻找DRG结付下住院费用超支原因,为公立医院精准控费提供参考。方法:选取医保类型、医疗行为、麻醉费用、住院天数作为前因条件,以模糊集定性比较分析方法进行条件之间的组态分析。结果:导致费用超支的核心路径有4条,居民医保、医疗行为(耗材费用、检查费用)、住院天数是主要原因。结论:住院费用超支是多方面因素综合作用的结果,但仍有重点管控方向可循,应强化对亏损病组的管控,提高控费精准性。
Objective To searched for the reasons that caused the hospitalization expenses to exceed the DRG payment amount,and to propose corresponding suggestions to control the expense accurately in public hospitals.Methods The type of medical insurance,medical behaviour,anesthesia cost,and length of hospital stay were selected as antecedent conditions,and fsQCA was applied to analyze the combined effect among the conditions.Results There were four core paths leading to overspending of hospitalization expenses,among which resident medical insurance,medical behaviour such as consumables cost and inspection cost,and length of hospital stay were the key elements.Conclusion The overspending of hospitalization expenses is the result of the comprehensive effect of many factors,but there are still key control directions to follow.To improve the accuracy of cost control,we should strengthen management of medical teams that generate more unreasonable costs and control of loss-making disease groups.
作者
张钰婉
卢亚娟
谈在祥
关雪凌
ZHANG Yuwan;LU Yajuan;TAN Zaixiang;GUAN Xueling(School of Management,Xuzhou Medical University,Xuzhou Jiangsu 221000,China;不详)
基金
江苏省社科基金一般专项“赋能江苏省康养产业发展的金融政策研究”(22JZB006)
江苏高校哲学社会科学研究基金项目“创新生态视角下江苏健康产业高质量发展研究”(2020SJA1072)
江苏省研究生科研与实践创新计划项目“DRG对公立医院经济运行的影响及医院内部管理改进研究”(KYCX22_2863)。
