按病种付费对新型农村合作医疗住院患者费用的影响分析:以乌鲁木齐为例

Analysis on the Effects of Diagnosis Related Groups on the Hospitalization Expenses for Patients under New Rural Cooperative Medical System: Taking Urumqi as an Example

目的:通过对乌鲁木齐市地区新型农村合作医疗定点医疗机构实施按病种付费前后的住院患者费用数据,进行对比分析,探讨按病种付费模式的实施对患者住院费用产生的影响。方法:通过建立数据库,对住院患者按照ICD-10分类,运用秩和检验和多元方差分析对按病种付费模式实施前后患者住院费用进行统计分析。结果:从住院总费用来看,病种付费有效控制了医疗费用的不合理上涨,其住院费用情况的差异有统计学意义(Z=3.445,P≤0.05);从住院费用结构来看,药品费用是影响住院费用的主要因素,其药品费的差异有统计学意义(F=14.929,P≤0.05)。结论:按病种付费在有效控制医疗费用的不合理上涨、限制过度医疗等方面具有积极意义。药品费用是影响住院费用的主要因素,政府、医疗机构和医疗保险机构应共同努力,采取综合措施,有效控制患者住院费用的过快增长。

Objective:Through comparing and analyzing the expense data of hospitalized patients in pilot medical institutions of New Rural Cooperative Medical System in Urumqi before and after implementing Diagnosis Related Groups(DRGs), the effects of implementing DRGs mode on hospitalization expenses for patients.Methods:Through establishing the database, according to ICD-10 classification, rank test and multivariate analysis were applied to perform statistic analysis on the hospitalization expenses for patients before and after the implementation of DRGs mode.Results:For the total cost of hospitalization, DRGs could effectively control the irrational rise of medical expenses, the differences of hospitalization expenses were statistically significant(Z=3.445, P≤0.05); from the structure of hospitalization costs, drug costs were the main factors affecting the cost of hospitalization, the difference had statistical significance(F=14.929, P≤0.05).Conclusion:DRGs had positive significance in effectively controlling medical expenses, over-restricting medical treatment, etc. Drug cost was the main factor of hospitalization cost. Government, medical institutions and medical insurance institutions should work together and take comprehensive measures so as to effectively control of the excessive growth of hospitalization cost.