DRG支付下某血液病专科医院医保结余分析与运营策略

Analysis on Medical Insurance Balance and Operation Strategy of a Hematology Specialized Hospital Under DRG Payment

目的:本研究通过对DRG支付下某血液病专科医院医保结余的影响因素分析,为医院更好地适应DRG支付政策促进精细化管理提供科学依据。方法:收集某三级甲等血液病专科医院2022年10月—2023年7月DRG实际付费病例数据,采用二元Logistic回归分析医保结余水平的影响因素。结果:本研究共纳入4018个病例,影响因素分析结果显示,不同入组病例、疾病分组、有无合并症/并发症、治疗操作分类、年龄、医保类型的病例DRG医保结余水平存在差异(P<0.05)。结论:DRG付费下,医疗机构应合理配置资源,优化费用结构,对疑难重症费用较高病例加强监测,合理管控成本,提升精细化管理水平。

Objectives:This study analyzes the medical insurance balance of a hematology specialized hospital under DRG payment reform and explores the influencing factors,providing scientific basis for hospitals to better adapt to DRG payment policies and promote refined management.Methods:The paper collects data of cases paid by DRG from a first-class hematology specialized hospital from October 2022 to July 2023,and uses binary logistic regression analysis to analyze the influencing factors of medical insurance balance level.Results:A total of 4018 cases were included in the study,and the analysis of influencing factors shows that there are differences in DRG medical insurance balance levels among cases with different enrollment cases,disease groups,presence or absence of comorbidities/complications,classification of procedures,age,and medical insurance type(P<0.05).Conclusions:Under DRG payment,medical institutions should allocate resources reasonably,optimize cost structure,strengthen monitoring of difficult and severe cases with high cost,reasonably control costs,and improve the level of refined management.