以带状疱疹为例初探中医医院应对DRGs的策略

Taking Shingles as an example to explore the strategies of traditional Chinese medicine hospitals in dealing with DRGs

目的 我国医疗费用快速上涨的问题日趋严峻,为解决此问题我国医保开始尝试以按疾病诊断相关分组(diagnosis related groups,DRGs)付费方式替代既往的按项目付费的支付方式。但中医医院目前尚未实施,本研究以带状疱疹为例对如果中医医院参加DRGs付费会面临怎样的情况,中医医院在哪些方面进行改变,才能够应对这一支付方式的改变进行初步探索。方法 采用横断面研究方法和SPSS 24.0统计软件,通过对2021年在天津市中医药研究院附属医院出院的带状疱疹患者出院费用的相关因素进行对比分析,研究哪些因素与住院费用具有相关性,以及医保两种付费方式下医院收入的差异。结果 发现DRGs支付方式对中医医院影响巨大,按DRGs支付的费用仅占原按项目付费的36.96%,尚不够支付药品和耗材的成本。而住院费用的影响因素主要和平均住院天数和不同的科室相关。结论 中医医院目前实施DRGs存在很多问题,既有医疗控费不佳,也有对DRGs认识不足。因此需要提高重视,提高入组准确率,同时落实好诊疗方案和临床路径。

Objective The problem of rapid increase in medical expenses in China is becoming increasingly severe.In order to solve this problem,China's medical insurance has begun to try to replace the previous pay-per-project payment method with diagnosis related groups(DRGs)payment.However,hospitals of traditional Chinese medicine have not implemented it yet.This study takes Shingles as an example to makes a preliminary exploration on what will happen if hospitals of traditional Chinese medicine participate in DRGs payment,and what changes should those hospitals make to cope with the change of this payment method.Methods A cross-sectional study and SPSS 24.0 statistical software were used to investigate which factors were associated with hospitalization costs of Shingles patients discharged from Tianjin academy of traditional Chinese medicine affiliated hospital in 2021,and the differences in hospital income between the two medicare payment methods.Results We found that the DRGs payment method has a great impact on traditional Chinese medicine hospitals.The payment by DRGs only accounts for 36.96%of the original payment by project,which is not enough to cover the cost of drugs and consumables.The influencing factors of hospitalization expenses are mainly related to the average length of stay and different departments.Conclusion There are many problems with the implementation of DRGs in traditional Chinese medicine hospitals,including poor medical cost control and insufficient understanding of DRGs.Therefore,it is necessary to pay more attention,improve the accuracy of enrollment,and implement the diagnosis and treatment plan and Clinical pathway.