基于DRG管理软件平台的病组收支模型构建

Construction of Patient Group Revenue and Expenditure Model Based on DRG Management Software Platform

随着DRG支付方式改革的不断推进,公立医院医保和运营管理面临巨大的挑战和机遇,降本增效是医院DRG管理的必由之路,因此亟需测算出准确合理的各病组成本。本研究探索以建立DRG管理软件平台为基础,通过统一医院全成本口径,结合成本费用比法计算扣除药品、耗材及医技分摊成本后病组的实际医疗收入;结合二级分摊法通过全院公共支出成本核算计算各科室需承担的每床日公共成本;建立适宜不同病种数据的病组收支结余模型。

With the continuous promotion of DRG payment reform,the medical insurance and operation management of public hospitals are faced with huge challenges and opportunities.It is urgent to calculate accurate and reasonable patient group costs to re-duce costs and improve efficiency of hospital DRG management.Based on the DRG management software platform,it explores to cal-culate the actual medical income of the patient group after deducting the cost of drugs,consumables and medical technology by unify-ing the full cost of the hospital and combining the cost ratio method;calculate the daily public cost of each bed to be borne by each department through the public expenditure cost accounting of the hospital based on the two-level allocation method;establish a dis-ease group balance model suitable for different disease data.