DRG支付制度改革对老年患者就诊费用的影响与政策建议

Impact of DRG payment system reform on medical costs for elderly patients:Analysis and policy recommendations

目的:分析南京市某老年病医院DRG付费改革前后医疗数据的变化,通过优化老年病医院的管理策略,可科学利用医保基金、促进医院高质量发展。方法:收集南京市某老年病医院支付制度改革前后住院患者医疗数据,分析制度对老年病医院运营的影响,并对支付制度改革政策优化提出建议。结果:老年病医院患者医疗服务需求与资源消耗随年龄同步增长;DRG支付制度改革推动医院注重绩效进步,CMI提升,住院费用结构发生改变,次均住院费用降低,平均住院日减少(P<0.05)。结论:DRG支付可以合理地控制医院住院费用不合理增长;医院通过科学有效的管理对策可提高医保基金使用效能;DRG政策设计应考虑高龄患者对医疗资源的刚性需求特点进行改革与调整。

Objective:To analyze the changes in medical data before and after the implementation of DRG payment system reform in a geriatric hospital in Nanjing,aiming to utilize medical insurance funds scientifically and promote high-quality hospital development.Methods:Medical data of inpatients before and after the payment system reform in a geriatric hospital in Nanjing were collected to analyze the impact of the system on hospital operations and to propose suggestions for the optimization of the payment system reform policy.Results:The demand for medical services and resource consumption at the geriatric hospital increased with age;the DRG payment system reform encouraged the hospital to focus on performance improvement,increased the case mix index(CMI),altered the structure of hospitalization costs,reduced the average cost per hospitalization,and decreased the average length of stay(P<0.05).Conclusion:The DRG payment system can reasonably control the unreasonable growth of hospitalization costs;effective management strategies can enhance the efficiency of medical insurance fund utilization;the design of DRG policies should consider the rigid demand characteristics of elderly patients for medical resources and adjust accordingly.