DRG支付政策实施前后患者住院费用比较分析

Comparative Analysis of Hospitalization Expenses of Patients before and after Implementation of DRG Payment Policy

目的分析DRG支付方式实施前后住院患者费用情况,为DRG支付方式的推进提供实证依据。方法以浙江省卫健委发布的DRG为分组标准,选取2018年至2021年医院病案首页数据,形成基础DRG数据。运用卡方检验、非参数秩和Mann-Whitney U检验、Wilcoxon检验进行数据差异性统计,比较分析DRG支付方式实施前后住院患者及住院费用情况。结果DRG支付方式实施后,DRG组数增加,CMI值上升,RW值分布结构更加优化,治愈/好转率提高,15天和31天再入院率下降,时间消耗指数基本持平,费用消耗指数上涨;住院费用总量下降,药费、耗材费、自付费用占比下降明显,医疗服务费、护理费有所提升,检查检验费略有上涨。结论DRG支付方式实施后,医院整体运行平稳,整体医疗费用控制良好,住院费用结构日趋优化,但需进一步关注检查检验费用,防止住院费用“内部转移”现象发生。

Objective To analyze the expenses of inpatients before and after the implementation of DRG payment policy,and to provide empirical evidence for the promotion of DRG payment.Methods Using DRG published by Health Commission of Zhejiang Province as grouping standard,the first page data of hospital medical records from 2018 to 2021 were selected to form basic DRG data.Chi-square test,nonparametric rank and Mann-Whitney U test and Wilcoxon test were used for data difference statistics.The inpatients and hospitalization expenses before and after the implementation of DRG payment policy were compared and analyzed.Results After the implementation of DRG payment policy,the number of DRG groups and the CMI value increased.The distribution structure of RW value was more optimized,the cure/recovery rate increased.The readmission rate decreased after 15 days and 31 days.The time consumption index was basically the same,and the cost consumption index increased.The total hospitalization expenses decreased.The proportion of medicine expenses,consumables expenses and out-of-pocket expenses decreased obviously.The medical service expenses and nursing expenses increased,and the inspection expenses increased slightly.Conclusion After the implementation of DRG payment policy,the overall operation of the hospital is stable,the overall medical expenses are well controlled,and the hospitalization expenses structure is increasingly optimized.However,more attention should be paid to the inspection expenses to prevent the"internal transfer"of hospitalization expenses.