DRG付费对康复专科住院医疗服务影响研究

Research on the Impact of DRG Payment on Inpatient Medical Services in Specialized Rehabilitation Institutions

目的:基于DRG指标的康复专科住院医疗服务情况进行研究,为开展精细化医院管理和推进医保支付改革提供参考依据。方法:选取广西某三甲医院康复专科2021年至2022年DRG付费下的所有住院病例为研究对象,计算其DRG组数、DRG总权重数、CMI值、时间消耗指数、费用消耗指数,分析不同年份康复专科DRG指标变化及影响因素。结果:与2021年相比,2022年DRG组数增加40.18%,RW≥2的例数下降88.65%,CMI值下降了5.29%,时间消耗指数下降了6.80%,费用消耗指数上升31.76%;与DRG改革前(2020年)相比,2022年平均住院日下降38.96%,次均费用下降24.51%。结论:DRG付费下,康复专科医院套用综合医院改革模式,使用同样的分组规则和权重方案,医疗服务效率逐年提升,但医疗服务能力变化不大。说明康复专科在DRG付费改革中取得一定成效,但其并不完全适用DRG付费。建议充分考虑康复专科特点,优化分组规则和权重方案,探索适宜康复专科的付费模式和医疗服务能力评价体系。

Objective:The paper studies the situation of inpatient medical services based on DRG indicators in specialized rehabilitation institutions,and provides a reference for refined hospital management and medical insurance payment reform.Methods:All inpatient cases paid by DRG from a tertiary hospital in Guangxi from 2021 to 2022 were selected as the research subjects.The number of DRG groups,total relative weight(RW)of DRG,CMI,time consumption index,and cost consumption index were calculated,and the changes and influencing factors of DRG indicators in specialized rehabilitation institutions in different years were analyzed.Results:Compared with 2021,the number of DRG groups increased by 40.18%,the number of cases whose RW was greater than or equal to 2 decreased by 88.65%,the CMI decreased by 5.29%,the time consumption index decreased by 6.80%,and the cost consumption index increased by 31.76%in 2022.Compared with the period before the DRG reform(2020),the average length of stay decreased by 38.96%,and the average cost per visit decreased by 24.51%in 2022.Conclusion:Under the DRG payment,specialized rehabilitation hospitals apply the comprehensive hospitals’reform model,with the same grouping rules and weight scheme.The efficiency of medical services is improving year by year,but the change in medical service capacity is not significant.The specialized rehabilitation hospitals achieve results under the DRG payment reform,but DRG payment is not fully suits them.It is recommended to fully consider the characteristics of specialized rehabilitation hospitals,optimize grouping rules and weight schemes,and explore suitable payment models and medical service capacity evaluation systems for specialized rehabilitation hospitals.