病组角度下浙江省医保DRG支付方式改革对住院费用的影响

Impact of medical insurance DRG payment reform on hospitalization expenses in Zhejiang Province from the perspective of patient group

目的 分析浙江省医保DRG支付方式改革对住院费用的影响。方法 采用描述性统计分析2020年和2021年清算分组地区住院均费的变化量和变化幅度,并用非参数检验分析浙江省某省级三甲医院住院费用变化情况。结果 七成左右的地区住院均费下调,同比下降5.38%。此外,除中药饮片费和手术费,样本医院三个DRG类型的各项费用和住院天数P值均小于0.05。除去其他政策影响,2021年样本医院平均住院日缩短,住院总费用、西药费和材料费有所下降。结论 DRG实施后,浙江省住院医疗费用得到了有效控制,循环和神经系统疾病的手术操作患者医疗负担明显减轻,医疗机构的成本意识、服务效率和能力主动提升,促进医、保、患三方共赢局面的形成,但“费用倒挂”、分解住院等问题仍需要关注。

Objective To analyze the impact of medical insurance DRG payment reform on hospitalization expenses in Zhejiang Province.Methods Descriptive statistics were used to analyze the amount and magnitude of change in the average hospitalization cost in the clearing subgroup areas in 2020 and 2021.Besides,non-parametric tests were used to analyze the change of inpatient expenses in a provincial tertiary hospital in Zhejiang Province.Results The average hospitalization expenses in about 70%of the regions were reduced,with a year-on-year decrease of 5.38%.In addition,except for traditional Chinese medicine decoction fees and surgery fees,the P-values of various expenses and hospitalization days for the three DRG types in the sample hospitals were all less than 0.05.Excluding other policy effects,the average hospital stay of the sample hospitals was shortened in 2021,along with a decrease in total hospitalization costs,Western medicine costs,and material costs.Conclusion After the implementation of DRG,inpatient medical expenses in Zhejiang Province have been effectively controlled.The medical burden of patients undergoing surgical procedures for circulatory and nervous system diseases has been significantly reduced,and the cost consciousness,service efficiency and capacity of medical institutions have been actively improved.It has promoted the formation of a win-win situation for medical institutions,insurance providers and patients.However,problems such as“fees inversion”and divided hospitalization still need attention.