基于疾病诊断相关分组成本的政策性价格扭曲测量与分析

Measurement and Analysis of Policy Price Distortions Based on Group Costs Associated with Disease Diagnosis

目的:测量样本医院673个疾病诊断相关分组(DRG)病组的政策性价格扭曲程度。方法:选取攀枝花市中心医院2021年病案首页73599份病例数据,剔除163份不合格病例数据和3188份未入组病例数据,最终入组70248个病例,共计生成673个DRG病组,涉及31个一级科室。采用项目叠加法核算DRG成本,利用政策性价格扭曲测量模型研究DRG病组价格与价值背离程度。结果:88.8%的DRG病组没有出现政策性价格扭曲或扭曲程度较小,9.1%的DRG病组为过低型政策性价格扭曲,2.1%的DRG病组为过高型政策性价格扭曲。产科、急诊科过低型政策性价格扭曲病例占比较高,分别占全部过低型价格扭曲病例数的60.66%、10.66%。非复杂诊断的阴道分娩、复杂诊断的阴道分娩、剖宫产不伴合并症/严重合并症、剖宫产伴合并症/严重合并症四个病组政策性价格扭曲程度分别为1.65、1.61、1.44、1.42,提示严重政策性价格扭曲。造成产科主要DRG病组政策性价格扭曲主要是手术、治疗、护理、诊查类项目。结论:本院DRG病组价格与价值存在偏离,且以过低型政策性价格扭曲为主。手术、治疗、护理类等体现医务人员劳务价值的项目价格与成本不匹配,产科、急诊科等体现公立医院公益性的科室存在价值扭曲。

Objective:To measure the degree of policy price distortion in 673 disease diagnosis related groups(DRG)in sample hospitals.Methods:73599 case data were selected from the home page of medical records of Panzhihua Central Hospital in 2021,and 163 unqualified case data and 3188 case data were excluded.Finally,70248 cases were enrolled,and a total of 673 DRG disease groups were generated,involving 31 first-level departments.The item superposition method was used to calculate the cost of DRG,and the policy price distortion measurement model was used to study the deviation degree of price and value in DRG disease group.Results:88.8%of DRG disease group did not have policy price distortion or the degree of distortion was small,9.1%of DRG disease group was too low policy price distortion,2.1%was too high policy price distortion.The cases of low policy price distortion in obstetrics and emergency department accounted for 60.66%and 10.66%of the total number of low policy price distortion cases respectively.The policy price distortion of vaginal delivery with uncomplicated diagnosis,vaginal delivery with complicated diagnosis,cesarean section without complications/severe complications,cesarean section with complications/severe complications were 1.65,1.61,1.44,1.42,respectively,indicating serious policy price distortion.The policy price distortion of the major DRG diseases in obstetrics was mainly caused by the items of surgery,treatment,nursing and examination.Conclusion:There is deviation between price and value in DRG patients in the hospital,and it is mainly distorted by excessively low policy price.The price and cost of the items reflecting the value of medical personnel labor such as surgery,treatment and nursing do not match,and the departments reflecting the public welfare of public hospitals such as obstetrics and emergency departments have value distortions.