人工关节集采对DRG IC29组病例住院费用的影响分析

Analysis of the impact of centralized procurement of artificial joints on hospitalization expenses of patients in DRG IC29

[目的]研究集中带量采购对人工关节置换术患者住院费用的影响,为深化高值耗材持续改革提供依据。[方法]收集某三级医院集采前后DRG分组IC29组病例的DRG结算数据和医保信息系统的相关信息,进行倾向得分匹配后,采用描述性分析、非参数检验、结构变动度进行费用变化分析。[结果]集采政策实施后的各项费用中位数显示,IC29组病例次均费用下降了33445元,其中材料费下降了34835元;DRG统筹金额下降了13705元,个人自付金额下降了24550元。集采前后的结构变动度为60.52%,材料费呈负向变动,医疗服务费、检查化验费、药品费及其他费呈正向变动。结构变动贡献率前三位为材料费50.00%、医疗服务费26.04%、检查化验费16.36%。[结论]集采后IC29组病例的次均费用、材料费、医保支付和个人负担费用均明显降低,费用结构得到优化,人工关节集中带量采购成效明显。建议持续进行高值耗材集采工作,并协同推进医疗服务价格和医院薪酬制度等其他医改配套政策。

Objective To study the impact of centralized volume-based procurement on the hospitalization cost of patients with artificial joint replacement,and to provide a basis for deepening the continuous reform of high-value consumables.Methods The DRG settlement data and the relevant information in the medical insurance information system of patients in DRG IC29 before and after centralized procurement in a tertiary hospital were collected.After propensity score matching,descriptive analysis,nonparametric tests,and degree of structure variation were used to analyze the changes of cost.Results The median of all expenses after the implementation of the centralized procurement policy showed that the average cost of each case in the IC29 group decreased by 33445 yuan,of which the material cost decreased by 34835 yuan.The amount of DRG decreased by 13705 yuan,and the amount of individual payment decreased by 24550 yuan.The degree of structure variation before and after centralized procurement was 60.52%,with a negative change in material fees and a positive change in medical service fees,diagnostic test fees,drug fees and other fees.The top three contribution rates of structural variation were 50%for materials,26.04%for medical services,and 16.36%for diagnostic tests.Conclusions After centralized procurement,the average cost,material cost,medical insurance payment and personal burden cost of IC29 group cases are significantly reduced;the cost structure is optimized,and the centralized volume-based procurement of artificial joints is effective.It is recommended that the centralized procurement of high-value consumables should be continued.Other supporting policies for medical reform,such as the pricing of medical services and the compensation system for hospitals,should be advanced in a coordinated manner.