基于DIP的肿瘤患者住院费用及成本管控策略研究

Study on Cost Analysis and Cost Control Strategy of Oncology Patient Hospitalization Based on DIP

目的 对按病种分值付费(Diagnosis-Intervention Packet,DIP)支付方式改革背景下广州市某三甲公立医院肿瘤病组住院患者的费用进行分析,并提出相应的成本管控策略。方法 选取改革前(2016年1月—2017年12月)患者3 474例和改革后(2018年1月—2020年12月)患者9 197例,采用ICD-5版本分组最终纳入558个DIP分组共计12 670例患者进行统计分析。结果 改革后住院总费用、手术费用、护理费用、治疗费用均具有正向反馈(P<0.05),一定程度上能减少患者的住院费用。D12.2、D12.4、D24.X病组盈亏与改革具有相关性,且疾病严重程度、住院日是其独立危险因素。结论 DIP支付方式改革政策下医院应强化控费意识,降低医疗成本;优化病种分值和入组设置,注重遴选优势病种;严控住院标准,避免低标入院等。

Objective To analyze the costs of inpatients in an inpatient oncology group in a tertiary grade A public hospital in Guangzhou under the context of the reform of payment by Diagnosis-Intervention Packet(DIP)and to propose corresponding cost control strategies.Methods 3474 patients before the reform(January,2016-Decem⁃ber,2017)and 9197 patients after the reform(January,2018-December,2020)were selected and a total of 12670 patients were finally included in 558 DIP subgroups using the ICD-5 version grouping for statistical analysis.Results The total hospitalization cost,operation cost,nursing cost,and treatment cost had positive feedback after the reform(P<0.05).To some extent,it can reduce patients’hospitalization cost.D12.2,D12.4,D24.X disease group profit and loss are correlated with reform,and disease severity and hospitalization days are their independent risk factors.Conclusion Hospitals should strengthen the awareness of cost control to reduce medical costs under the payment reform policy of payment by disease type points;optimize the value of disease types and admission set⁃tings,focus on selecting superior disease types;strictly control hospitalization standards,and avoid low standard admissions,etc.