DIP改革对骨质疏松症患者住院费用影响研究

A Study of Impact of DIP Reform on Hospitalization Costs of Patients with Osteoporosis

目的通过对按病种分值付费(Diagnosis-Intervention Packet,DIP)改革前后骨质疏松患者住院费用的构成及费用变动情况进行分析,为有效管控医疗费用、完善医保支付方式改革提供对策和建议。方法选取2018—2021年成都市某三级甲等医院骨质疏松症患者住院费用信息,运用新灰色关联和结构变动分析法对患者费用结构变化情况及关联度进行定量分析。结果2018—2021年,诊断费是次均住院费用中构成比和关联度最大的影响因素,关联度均为1.0000。其次是药品费;结构变动贡献率前3位的费用是综合医疗服务费、诊断费、治疗费,3项费用的累计贡献率为89.95%;诊断费和治疗费呈现负向贡献变动,综合医疗服务费和耗材费呈正向贡献变动。结论DIP改革对骨质疏松患者费用结构优化具有导向作用,但仍有优化空间。住院费用中诊断费、药品费占比较大,医院补偿机制仍需进一步调整,医务人员技术劳务价值仍有待提高。DIP改革下一步需重点关注病种成本核算,从而更好地实现精准付费。

Objective To analyze the composition and variation of inpatient cost among osteoporosis patients before and after the Diagnosis-Intervention Packet(DIP)payment reform,to provide countermeasures for effectively con⁃trolling medical expenses and improving the reform of medical insurance payment methods.Methods Data on the in⁃patient cost of patients with osteoporosis was collected in a grade-Ⅲtertiary general hospital in Chengdu during 2018-2021.The structural change and correlation degree of patient cost were quantitatively analyzed by using new gray correlation and degree of structure variation analysis.Results From 2018 to 2021,the diagnostic fee was the ma⁃jor influential factor in the composition ratio and correlation degree of the average hospitalization cost,correlation de⁃gree all 1.0000,and the second one was drug cost.The top three costs of contribution rate of structural variation were comprehensive medical service fees,diagnosis fees,and treatment fees,with a cumulative contribution rate of 89.95%;Diagnostic fees and treatment fees showed negative contribution changes,while comprehensive medi⁃cal service fee and consumables feeshowed positive contribution changes.Conclusion DIP payment reform has a guiding effect on the optimization of cost structure of osteoporosis patients,but there is still room for optimization.Among the hospitalization costs,the cost of diagnosis and drugs accounted for a relatively large amount,hospital compensation mechanisms still need further adjustment.The value of technical and labor services of medical person⁃nel still needs to be improved.The next step of DIP payment reform needs to focus on disease cost accounting,to better implement accurate payment.