DIP改革下医院病种成本管理的实践探索——以平顶山市某三级医院为例

Practice and Exploration of Hospital Disease Cost Management Under the DIP Reform——A Case Study of a Tertiary Hospital in the City of Pingdingshan

目的:分析实施按病种分值付费支付方式改革下医院病种成本管理的结果与成效,探索降本增效、实现其内部精细化管理的方法。方法:以样本医院2022—2023年全院及重点特色科室——心内科的DIP入组病例作为研究样本,采用比较分析法和Mann-Whitney秩和检验法,从“医院—科室—病种”三个维度对DIP病种成本管理状况进行统计分析。结果:2023年,全院DIP病种入组率提高,高、低倍率病例占比、次均成本及药占比下降。心内科次均住院费用、综合治疗服务费、药品费与耗材费显著降低(P<0.05);次均住院费用、病种分值、平均住院日与药占比对病种的盈亏影响显著(P<0.05);重点病组通过病种结构调整,提高了医保结余金额。结论:深化DIP支付方式改革、加强病种成本管理,有助于提升医院的医疗服务质量与效率,也有助于提高医保资金的使用效率。

Objective:The paper analyzes the results and effectiveness of disease cost management under the reform of DIP payment method,and explores the methods of reducing cost and increasing efficiency to realize fine management of hospitals.Methods:DIP cases of the whole hospital and the Department of Cardiology(one of the key characteristic departments)from 2022 to 2023 were taken as samples,and comparative analysis and Mann-Whitney rank sum test were applied to conduct statistical analysis of the DIP disease cost management from the three dimensions of"hospital-department-disease".Results:In 2023,the enrollment rate of DIP diseases increased,the proportion of extremely high and low-cost cases decreased,the average cost per case and the proportion of drug cost decreased.The average hospitalization cost,comprehensive treatment service fee,drug cost and consumable cost were significantly decreased(P<0.05).The average hospitalization cost,disease score,average length of stay and proportion of drug cost had significant impact on the profit and loss of disease(P<0.05).The medical insurance balance amount of key disease groups was increased with the adjustment of disease structure.Conclusion:Deepening the reform of DIP payment method and strengthening the management of disease cost is conducive to improving the quality and efficiency of hospital medical service and the efficiency of medical insurance funds.