DIP付费试点下内蒙古某三甲医院按病种医疗费用控制研究

Research on the control of medical expenses by Diagnosis-Intervention Packet in a tertiary hospital in Inner Mongolia

[目的]为有效降低住院医疗费用、减轻群众就医负担提供实证依据。[方法]收集国家DIP付费试点城市某医院试点前(2021年)与试点后(2022-2023年)相应数据。采用结构变动度分析方法对医疗费用结构进行分析,采用方差分析法对各年度参保住院患者医疗费用负担的差异性进行分析。[结果]2021-2023年度次均住院总费用、药品费、耗材费、实验室检查费、影像检查费、其他医疗服务费间差异均具有统计学意义(P<0.01)。2021-2022年医疗费用结构变动度(23.71%)最高,其中,影像学检查占比结构变动值为-6.52%,药品费用占比结构变动值为-5.33%。2021-2023年,各年住院患者医保报销费用、患者自付费用、患者自付比例差异均具有统计学意义(P<0.001)。[结论]按病种医疗费用控制工作的开展,使住院总费用呈逐年下降趋势,药品费用、影像学检查费用下降幅度较大,但耗材费用与实验室检查费结构变动幅度较小。

Objective To provide an empirical basis for effectively reducing hospitalization expenses and reducing the burden of medical treatment for the masses.Methods The corresponding data from a hospital in a national pilot city of DIP payment before the trial(2021)and after the trial(2022-2023)were collected.The structural variation was used to analyze the structure of medical expenses,and the analysis of variance was used to analyze the differences of medical expenses of insured inpatients in each year.Results The differences in the average hospitalization expenses per visit,medicine expenses,consumables expenses,laboratory tests cost,imaging examinations expenses,and other medical service expenses from 2021 to 2023 were statistically significant(P<0.01).The structural variation of medical expenses from 2021 to 2022 was the highest(23.71%).The structural variation of the proportion of imaging examinations was-6.52%,and the structural variation of the proportion of medicine expenses was-5.33%.From 2021 to 2023,the differences in the healthcare reimbursement of inpatients in each year,out-of-pocket costs and the out-of-pocket ratio were statistically significant(P<0.001).Conclusions The total hospitalization expenses show a downward trend year by year through the control of medical expenses by Diagnosis-Intervention Packet.The costs of medicines and imaging examinations have decreased significantly,but the structural variation of consumables expenses and laboratory tests cost is relatively small.