DRG支付对急性胰腺炎患者住院费用影响分析——基于中断时间序列模型研究

Analysis of the Impact of DRG Payment on Hospitalization Costs in Patients with Acute Pancreatitis——A Study Based on the Interrupted Time Series Model

目的:本研究选取浙江省某三甲医院2019年至2021年的急性胰腺炎患者结算数据,评估DRG改革前后患者住院费用的变化,旨在为政策的持续优化提供实证依据。方法:采用中断时间序列模型分析政策执行前后住院费用变化趋势,并通过Spearman相关分析探讨住院总费用与各构成部分费用的关联度。结果:分析显示,改革前住院总费用每月上升1639.3元(P<0.001),改革后每月下降1924.1元(P<0.001),药品费和医疗服务费每月分别下降910.0元和480.3元(P<0.001)。改革后,医疗服务费与住院总费用的相关性最强(r=0.941,P<0.001)。结论:研究发现,随着DRG改革实施,样本医院急性胰腺炎患者的住院费用逐年下降,表明改革效果显著。医疗机构通过加强药品和耗材管控及规范医疗行为,有效体现了政策要求。为进一步提升DRG政策的调控作用,建议调整医疗服务价格以激励医务人员,同时建立动态调整机制,优化DRG分组方案,确保政策更好地适应临床需求和医疗实践。

Objective:Patients with acute pancreatitis from 2019 to 2021 in a tertiary hospital in Zhejiang Province were included in the study to evaluate the changes in patient hospitalization costs before and after the DRGs reform,aiming to provide empirical evidence for the continuous optimization of the policy.Methods:The interrupt time series model was used to analyze the trend of hospitalization costs before and after the implementation of the policy,and Spearman correlation analysis was used to explore the correlation between the total hospitalization costs and the costs of each component.Results:The analysis showed that the total hospitalization cost increased by 1639.3 yuan per month before the reform(P<0.001),decreased by 1924.1 yuan per month after the reform(P<0.001),and the drug cost and medical service fee decreased by 910.0 yuan and 480.3 yuan per month,respectively(P<0.001).After the reform,the medical service fee showed the strongest correlation with the total hospitalization cost(r=0.941,P<0.001).Conclusion:The study found that with the implementation of DRG reform,the hospitalization cost of acute pancreatitis patients in the sample hospital decreased year by year,indicating that the reform effect was significant.Medical institutions responded effectively to the policy change by strengthening the control of drugs and consumables and standardizing medical behavior.In order to further enhance the regulatory role of DRG policy,it is suggested to adjust the price of medical service to motivate medical personnel,and establish a dynamic adjustment mechanism to optimize the DRG grouping scheme to ensure that the policy better meets clinical requirement and medical practice.