DRG付费下肿瘤专科医院住院费用分析

Analysis of Hospitalization Costs in Tumor Specialty Hospitals under DRG Payment

目的对某肿瘤专科医院按照DRG付费后的住院费用进行分析,评价DRG付费改革工作的实施效果,为进一步完善DRG分组机制和加强医院精细化管理提供参考依据。方法以实际付费后次均费用、费用构成、病例组合指数(CMI)等的变化来评价DRG付费改革工作的实施效果,使用t检验、非参数检验等对相关数据进行统计分析。结果改革后住院次均医疗费用下降;费用构成上药品费、材料费、检查费、手术费比例下降,治疗费比重上升;医院整体病种结构调整收治外科组比例上升、内科组下降,入组率、CMI上升,费用消耗指数下降。结论DRG付费能够促使医院加强内部管理,控制医疗费用,调整收治病种结构;医院内部管理中要持续优化费用结构,进一步提高体现劳务价值的手术费、治疗费占比。医保部门要不断完善分组机制,加强对新技术支持,促进医疗机构健康发展。

Objective:To analyze the hospital expenses after DRG payment in a cancer hospital,evaluate the implementation effect of DRG payment reform,and provide references for further improving the DRG grouping mechanism and strengthening the hospital's refined management.Method:The implementation effect of DRG payment reform was evaluated by the changes of actual post-payment average cost,cost composition and case portfolio index(CMI),and the relevant data were statistically analyzed by t test and non-parametric test.Result:After the reform,the average medical cost per hospitalization decreased.The proportion of cost components including medication,material,examination,and surgery costs has decreased,while the proportion of treatment costs has increased.The overall disease structure adjustment of the hospital has led to an increase in the proportion of patients admitted to the surgical group,a decrease in the internal medicine group,an increase in enrollment rate and CMI,and a decrease in the cost consumption index.Conclusion:DRG payment can encourage hospitals to strengthen internal management,control medical expenses,and adjust the structure of admitted diseases.In the internal management of hospitals,it is necessary to continuously optimize the cost structure and further increase the proportion of surgical and treatment expenses that reflect the value of labor.The medical insurance department should continuously improve the grouping mechanism,strengthen support for new technologies,and promote the healthy development of medical institutions.