DRG付费模式下公立医院病组运行结果分析

Analysis of the Operational Results of Disease Groups in Public Hospitals Under the DRG Payment Model

目的分析广西某公立医院实施疾病诊断相关分组(diagnosis-related groups,DRG)支付方式改革后2022年DRG运行数据,讨论实施DRG付费改革后医院运营管理面临的挑战,并提出相应的对策。方法采用描述性统计分析方法对目标医院2022年7—12月DRG运行后的数据进行分组数据对比和盈亏分析。结果主要诊断大类(major diagnostic category,MDC)覆盖的结算情况看,亏损的MDC较多,但不同的MDC亏损比例不同,不同的专科面临的控费风险压力差异性大。总体亏损仅占总费用总额的6.81%,医院运营风险变大,疑难危重高费用患者以及高新医疗技术发展面临挑战。结论公益医院应重塑医院内部管理体系,全院一盘棋,协同应对医保支付方式改革。建立DRG付费体系下统一的院内成本核算和监控体系,提升院内信息管理系统并建立相应的医保医生考核激励机制。通过加强医保部门的谈判沟通,促进医、保、患三方协同发展。

Objective To analyze the DRG operation data of a public hospital in Guangxi in 2022 after the implementation of DRG payment reform,discussed the challenges faced by the hospital operation and management after the implementation of DRG payment reform,and proposed corresponding countermeasures.Methods Descriptive statistical analysis was used to compare the grouped data and analyze the profit and loss of the data after DRG operation data from July to December 2022.Results There were more DRG deficit patients in hospitals,and the risk pressure of cost control was different among different specialties.The risk of hospital operation has become greater,and the development of difficult and critical patients with high costs and high-tech medical technology is facing challenges.Conclusion Public hospitals should reshape the internal management system of hospitals,and cooperate with the reform of medical insurance payment methods.Establish a unified hospital cost accounting and monitoring system under the DRG payment system,improve the hospital information management system and establish the corresponding medical insurance doctor evaluation incentive mechanism.Through strengthening the negotiation and communication of medical insurance departments,the coordinated development of medical,insurance and patients will be promoted.