按DRGs付费的内科医保患者住院日对总费用的影响

Effect of Hospitalization Days of Medical Insurance Patients according to DRGs on the Total Cost

目的研究DRGs付费的内科医保患者的住院日与总费用的关系,以便为DRGs付费后住院日的管理提供参考。方法选取2016年-2018年于某三甲医院内科住院的沈阳市医保患者中的不稳定性心绞痛972人、脑梗死1,125人、结肠息肉252人、肺炎390人、慢性肾功能不全222人和类风湿性关节炎196人,共3,160人作为研究对象。采用线性回归模型分析DRGs付费后住院日对总费用的影响。结果 DRGs付费前后高住院日组的总费用中位数都高于低住院日组(DRGs付费后:14 812.48 vs 10 437.4,P<0.001;DRGs付费前:13 653.52 vs 98 42.53, P<0.001)。DRGs付费前后总费用均随住院日的增加均呈现增高趋势(P均<0.001)。在多因素回归中,住院日每增加1天总费用升高1570.36元(95%CI 1249.00至1891.71,P<0.001)。结论 DRGs付费后住院日依然是内科医保患者住院总费用的非常重要影响因素,DRGs管理联合住院日管理是降低总费用和避免医保超支的有效途径。

Objective To explore the relationship between the length of stay(LOS)and the total hospitalization expenses for medical insurance inpatients with DRGs payment to provide a reference for the administration of LOS.Methods From year 2016 to 2018,972 patients with unstable angina pectoris,1,125 patients with cerebral infarction,252 patients with colonic polyps,390 patients with pneumonia,222 patients with chronic renal insufficiency and 196 patients with rheumatoid arthritis who were hospitalized in the internal medicine department of a third-grade hospital Shenyang were selected as samples.Linear regression model was used to analyze the impact of LOS after DRGs payment on the total cost.Results The median total cost of the high-LOS group was higher than that of the low-LOS group both before and after DRGs payment(after DRGs payment:14812.48 vs 10437.4,P<0.001;before DRGs payment:13653.52 vs 9842.53,P<0.001).Both before and after DRGs payment,the total cost had an increasing trend with the increment of LOS(trend test P<0.001).In the multivariate regression model,the total cost after DRGs payment increased with the increment of LOS.the total cost increased by 1571.36 yuan(95%CI1249.00 to 1891.71,P<0.001)for each additional day of LOS.Conclusions During DRGs payment,the length of stay is still a very important factor in the total hospitalization cost of medical insurance patients.Combination administration of DRGs and length of stay is an effective way to reduce the total cost and avoid over-expenditure.