DRG付费对脑梗死患者费用结构及医疗行为的影响研究

Study on the impact of DRG payment on the cost structure and medical treatment of patients with cerebral infarction

[目的]分析DRG付费对脑梗死患者的住院费用结构及医疗行为可能产生的影响,了解DRG付费实施后对临床产生的影响及医疗机构的应对措施。[方法]分析首都医科大学宣武医院DRG付费改革前后“脑梗死”病组837例患者的费用结构,并结合对该院162名临床医生发放的问卷进行调查,统计分析费用构成及医疗行为变化情况。[结果]DRG付费后“脑梗死”患者费用构成中药占比明显下降,检查费、化验费、治疗费占比显著提升,平均住院日有所降低。DRG付费后医疗机构可能存在异化行为和患者选择偏见的风险。[结论]研究表明DRG付费制度对优化医疗机构费用结构、提高治疗效率起到积极作用,也对医疗行为的规范起到了促进作用。同时也产生了推诿病人、低码高编等异化行为,医保经办机构应积极探索适应DRG付费制度的监管新措施。

Objective To analyze the possible influence of DRG payment on the hospitalization cost structure and medical treatment of patients with cerebral infarction,and to understand the impact of DRG payment on clinical practice and countermeasures of medical institutions.Methods This paper analyzed the cost structure of 837 patients with cerebral infarction before and after the DRG payment reform in Xuanwu Hospital of Capital Medical University,and 162 questionnaires were distributed to clinicians in the hospital for survey.The composition of expenses and the change of medical treatment were analyzed statistically.Results After DRG payment,the proportion of drugs in the cost structure of patients with cerebral infarction decreased significantly.The proportion of check-up cost,laboratory cost,and treatment cost increased significantly,and the average length of stay decreased.There would be risks of abnormal behaviors and the bias for patient selection in medical institutions after DRG payment.Conclusions The research shows that DRG payment system plays a positive role in optimizing the cost structure of medical institutions,improving treatment efficiency and promoting the standardization of medical treatment.However,there are some abnormal behaviors such as buck-passing in admitting patients and upcoding medicare.Medical insurance agencies should actively explore new regulatory measures to adapt to DRG payment system.