基于CHS-DRG的ES2病组分组效果与费用分析

Grouping effect and expense analysis of ES2 disease group based on CHS-DRG

目的分析基于国家医疗保障疾病诊断相关分组的呼吸系统感染/炎症(ES2)病组分组效果和住院费用结构变化,为按疾病诊断相关分组付费改革提供参考。方法收集某三级甲等医院2017年1月1日至2021年12月31日ES2病组住院费用及明细,使用变异系数、方差减少量分析分组效果,使用结构变动度和灰色关联度分析该病组住院费用结构的变动及关联性。结果ES2病组中的ES20病组和ES25病组的组内一致性尚可,而ES21病组和ES23病组的组内差异较大,4个病组的组间异质性欠佳。ES2病组住院费用关联度较高的项目为药品费、化验费、检查费,对次均费用结构变动度贡献率较高的项目为检查费、药品费、治疗费。结论当地医保部门仍需细化ES2病组分组内容,制订更为合理的政策以调整住院费用结构,并大力推进分级诊疗制度。

Objective To analyze the grouping effect of respiratory infection/inflammation(ES2)disease group based on China Healthcare Security Diagnosis-Related Groups and the changes of hospitalization expense structure,and to provide reference for Diagnosis-Related Groups payment reform.Methods The hospitalization expenses and details of ES2 disease groups in a classⅢlevel A hospital from January 1,2017 to December 31,2021 were collected,and the grouping effect was analyzed by using the coefficient of variation and variance reduction.The structural change and correlation of hospitalization expenses in this disease group were analyzed by using structural variation and grey relational analysis.Results In the ES2 disease group,the intra-group consistency of the ES20 disease group with ES25 disease group was acceptable,while the intra-group difference between the ES21 and ES23 disease groups were large,and the heterogeneity among the four disease groups was poor.The items with higher correlation degree of hospitalization expenses in ES2 disease group were drug cost,laboratory cost and examination cost,and the items with higher contribution rate to the structural variation of the average cost per time were examination cost,drug cost and treatment cost.Conclusion The ES2 disease group of local medical insurance still needs to refine the grouping content,formulate more reasonable policies to adjust the hospitalization expense structure,and vigorously promote the hierarchical medical system.