BACKGROUND In 2018,the diagnosis-related groups prospective payment system(DRGs-PPS)was introduced in a trial operation in Beijing according to the requirements of medical and health reform.The implementation of the s...BACKGROUND In 2018,the diagnosis-related groups prospective payment system(DRGs-PPS)was introduced in a trial operation in Beijing according to the requirements of medical and health reform.The implementation of the system requires that more than 300 disease types pay through the DRGs-PPS for medical insurance.Colorectal cancer(CRC),as a common malignant tumor with high prevalence in recent years,was among the 300 disease types.AIM To investigate the composition and factors related to inpatient medical expenditure in CRC patients based on disease DRGs,and to provide a basis for the rational economic control of hospitalization expenses for the diagnosis and treatment of CRC.METHODS The basic material and cost data for 1026 CRC inpatients in a Grade-A tertiary hospital in Beijing during 2014-2018 were collected using the medical record system.A variance analysis of the composition of medical expenditure was carried out,and a multivariate linear regression model was used to select influencing factors with the greatest statistical significance.A decision tree model based on the exhaustiveχ^2 automatic interaction detector(E-CHAID)algorithm for DRG grouping was built by setting chosen factors as separation nodes,and the payment standard of each diagnostic group and upper limit cost were calculated.The correctness and rationality of the data were re-evaluated and verified by clinical practice.RESULTS The average hospital stay of the 1026 CRC patients investigated was 18.5 d,and the average hospitalization cost was 57872.4 RMB yuan.Factors including age,gender,length of hospital stay,diagnosis and treatment,as well as clinical operations had significant influence on inpatient expenditure(P<0.05).By adopting age,diagnosis,treatment,and surgery as the grouping nodes,a decision tree model based on the E-CHAID algorithm was established,and the CRC patients were divided into 12 DRG cost groups.Among these 12 groups,the number of patients aged≤67 years,and underwent surgery and chemotherapy or radiotherapy was largest;while patients aged>67 years,and underwent surgery and chemotherapy or radiotherapy had the highest medical cost.In addition,the standard cost and upper limit cost in the 12 groups were calculated and re-evaluated.CONCLUSION It is important to strengthen the control over the use of drugs and management of the hospitalization process,surgery,diagnosis and treatment to reduce the economic burden on patients.Tailored adjustments to medical payment standards should be made according to the characteristics and treatment of disease types to improve the comprehensiveness and practicability of the DRGs-PPS.展开更多
BACKGROUND Data from the World Health Organization’s International Agency for Research on Cancer reported that China had the highest prevalence of cancer and cancer deaths in 2022.Liver and pancreatic cancers account...BACKGROUND Data from the World Health Organization’s International Agency for Research on Cancer reported that China had the highest prevalence of cancer and cancer deaths in 2022.Liver and pancreatic cancers accounted for the highest number of new cases.Real-world data(RWD)is now widely preferred to traditional clinical trials in various fields of medicine and healthcare,as the traditional research approach often involves highly selected populations and interventions and controls that are strictly regulated.Additionally,research results from the RWD match global reality better than those from traditional clinical trials.AIM To analyze the cost disparity between surgical treatments for liver and pancreatic cancer under various factors.METHODS This study analyzed RWD 1137 cases within the HB1 group(patients who underwent pancreatectomy,hepatectomy,and/or shunt surgery)in 2023.It distinguished different expenditure categories,including medical,nursing,technical,management,drug,and consumable costs.Additionally,it assessed the contribution of each expenditure category to total hospital costs and performed cross-group comparisons using the non-parametric Kruskal–Wallis test.This study used the Steel–Dwass test for post-hoc multiple comparisons and the Spearman correlation coefficient to examine the relationships between variables.RESULTS The study found that in HB11 and HB13,the total hospitalization costs were significantly higher for pancreaticoduodenectomy than for pancreatectomy and hepatectomy.Although no significant difference was observed in the length of hospital stay between patients who underwent pancreaticoduodenectomy and pancreatectomy,both were significantly longer than those who underwent liver resection.In HB15,no significant difference was observed in the total cost of hospitalization between pancreaticoduodenectomy and pancreatectomy;however,both were significantly higher than those in hepatectomy.Additionally,the length of hospital stay was significantly longer for patients who underwent pancreaticoduodenectomy than for those who underwent pancreatectomy or liver resection.CONCLUSION China Healthcare Security Diagnosis Related Groups payment system positively impacts liver and pancreatic cancer surgeries by improving medical quality and controlling costs.Further research could refine this grouping system and ensure continuous effectiveness and sustainability.展开更多
China has been undertaking a profound reform on health care.Although more than 1.16 billion people have been covered by rural and urban medical insurance to date,the level of reimbursement from insurance is very limit...China has been undertaking a profound reform on health care.Although more than 1.16 billion people have been covered by rural and urban medical insurance to date,the level of reimbursement from insurance is very limited,especially for critical diseases such as leukemia.This places heavy economic burdens on patients.Under these circumstances,systems innovation is imperative for the efficient utilization of limited funding.In this respect,certain valuable experience from other countries may prove helpful.The prospective payment system of Diagnosis-related Groups(DRGs),Clinical Paths,and the Comparative Effectiveness Analysis adopted by the National Institute of Health and Clinical Excellence(NICE,UK),can befine tools to reduce medical costs and improve quality of services.Treatments of acute promyelocytic leukemia at Rui-Jin Hospital,and childhood acute lymphoblastic leukemia at Shanghai Children’s Medical Center,can be taken as suitable models to illustrate the crucial role of Clinical Paths in guaranteeing clinical and cost effectiveness of medical services for critical diseases,and to satisfactorily justify the feasibility of DRGs in China.展开更多
Objective To study the successful experience of implementing diagnosis related group(DRG)payment system in the United States and provide a reference for China’s reform of health insurance payment.Since the United Sta...Objective To study the successful experience of implementing diagnosis related group(DRG)payment system in the United States and provide a reference for China’s reform of health insurance payment.Since the United States is the first country to develop and apply the DRG in the world,its research and practice of DRG are always at the forefront.Methods Literature research method was used to investigate DRG payment system,the specific steps of the payment,the setting method of relevant indicators,and the quality supervision measures.Results and Conclusion There are mainly three aspects from the experience of DRG payment system in the United States.Firstly,the government’s responsibility for health insurance is clarified.Secondly,the relevant indexes are set reasonably.Thirdly,the DRG weight and base rate are adjusted dynamically to ensure the fairness of DRG payment.Therefore,China should pay attention to the following three aspects:clarifying the main responsibility of the government in the reform of health insurance payment,establishing the quality control system of the first page of medical records,and improving the supervision mechanism for medical quality.展开更多
Objective To implement the national diagnosis related group(DRG)policy smoothly,and gradually move towards value medicine and fine management,some suggestions are put forward for improving medical service efficiency,s...Objective To implement the national diagnosis related group(DRG)policy smoothly,and gradually move towards value medicine and fine management,some suggestions are put forward for improving medical service efficiency,saving medical insurance fund,and reducing the burden of patients,so as to realize the win-win situation of medical insurance and patients.Methods Based on the experience of the United States,Australia,and Germany,the policy implementation background and development process in China were summarized.The advantages and disadvantages of single disease payment method,disease score payment method,and diagnosis related groups-prospective payment system(DRG-PPS)method were compared,and then the problems were found out.Results and Conclusion In view of the imperfect information system,lack of professional talents,and uneven progress of each pilot,it is proposed that relevant departments should pay more attention to the construction and improvement of coding and other information systems,cultivate professional talents,promote the reform of DRG payment technology specification and grouping technology combined with national pilot project,thus enhancing the application and in-depth development of DRG policy in China.展开更多
本文阐述了病案管理在疾病诊断相关分组(Diagnosis Related Groups,DRG)支付体系中的重要性,包括病案信息的准确性和完整性对病种分组和支付标准的影响。分析了当前病案管理存在的问题,如病案质量不高、病案编码不规范、病案数据利用不...本文阐述了病案管理在疾病诊断相关分组(Diagnosis Related Groups,DRG)支付体系中的重要性,包括病案信息的准确性和完整性对病种分组和支付标准的影响。分析了当前病案管理存在的问题,如病案质量不高、病案编码不规范、病案数据利用不足等。针对这些问题,本文提出了一系列病案管理优化策略,包括完善病案信息收集和整理流程、加强对病案信息收集和整理人员的培训、建立病案质量控制机制等。本文还讨论了病案管理策略优化在DRG支付体系中的意义与价值以及未来研究方向。展开更多
2024年7月,国家医保局发布《关于印发按病组和病种分值付费2.0版分组方案并深入推进相关工作的通知》,标志着我国疾病诊断相关分组(diagnosis related group,DRG)支付改革正式迈入2.0时代。2.0版分组方案中,DRG增加了6组,核心DRG增加了3...2024年7月,国家医保局发布《关于印发按病组和病种分值付费2.0版分组方案并深入推进相关工作的通知》,标志着我国疾病诊断相关分组(diagnosis related group,DRG)支付改革正式迈入2.0时代。2.0版分组方案中,DRG增加了6组,核心DRG增加了33组,具有分组更科学合理、更契合临床实际情况的特点。国家医保局同步明确了5个配套管理机制,即特例单议机制、基金预付机制、谈判协商机制、意见收集反馈机制和数据公开机制,旨在优化DRG支付改革管理,确保医疗机构、医保部门和患者实现多方共赢。2.0版的发布,为医疗机构提供了更精细化的管理工具和更合理的支付机制。医疗机构应积极拥抱该项改革,通过优化内部管理和提高服务质量,实现成本控制和效率提升,最终达到患者、医保基金和医疗机构三方共赢。展开更多
文摘BACKGROUND In 2018,the diagnosis-related groups prospective payment system(DRGs-PPS)was introduced in a trial operation in Beijing according to the requirements of medical and health reform.The implementation of the system requires that more than 300 disease types pay through the DRGs-PPS for medical insurance.Colorectal cancer(CRC),as a common malignant tumor with high prevalence in recent years,was among the 300 disease types.AIM To investigate the composition and factors related to inpatient medical expenditure in CRC patients based on disease DRGs,and to provide a basis for the rational economic control of hospitalization expenses for the diagnosis and treatment of CRC.METHODS The basic material and cost data for 1026 CRC inpatients in a Grade-A tertiary hospital in Beijing during 2014-2018 were collected using the medical record system.A variance analysis of the composition of medical expenditure was carried out,and a multivariate linear regression model was used to select influencing factors with the greatest statistical significance.A decision tree model based on the exhaustiveχ^2 automatic interaction detector(E-CHAID)algorithm for DRG grouping was built by setting chosen factors as separation nodes,and the payment standard of each diagnostic group and upper limit cost were calculated.The correctness and rationality of the data were re-evaluated and verified by clinical practice.RESULTS The average hospital stay of the 1026 CRC patients investigated was 18.5 d,and the average hospitalization cost was 57872.4 RMB yuan.Factors including age,gender,length of hospital stay,diagnosis and treatment,as well as clinical operations had significant influence on inpatient expenditure(P<0.05).By adopting age,diagnosis,treatment,and surgery as the grouping nodes,a decision tree model based on the E-CHAID algorithm was established,and the CRC patients were divided into 12 DRG cost groups.Among these 12 groups,the number of patients aged≤67 years,and underwent surgery and chemotherapy or radiotherapy was largest;while patients aged>67 years,and underwent surgery and chemotherapy or radiotherapy had the highest medical cost.In addition,the standard cost and upper limit cost in the 12 groups were calculated and re-evaluated.CONCLUSION It is important to strengthen the control over the use of drugs and management of the hospitalization process,surgery,diagnosis and treatment to reduce the economic burden on patients.Tailored adjustments to medical payment standards should be made according to the characteristics and treatment of disease types to improve the comprehensiveness and practicability of the DRGs-PPS.
基金Research Center for Capital Health Management and Policy,No.2024JD09.
文摘BACKGROUND Data from the World Health Organization’s International Agency for Research on Cancer reported that China had the highest prevalence of cancer and cancer deaths in 2022.Liver and pancreatic cancers accounted for the highest number of new cases.Real-world data(RWD)is now widely preferred to traditional clinical trials in various fields of medicine and healthcare,as the traditional research approach often involves highly selected populations and interventions and controls that are strictly regulated.Additionally,research results from the RWD match global reality better than those from traditional clinical trials.AIM To analyze the cost disparity between surgical treatments for liver and pancreatic cancer under various factors.METHODS This study analyzed RWD 1137 cases within the HB1 group(patients who underwent pancreatectomy,hepatectomy,and/or shunt surgery)in 2023.It distinguished different expenditure categories,including medical,nursing,technical,management,drug,and consumable costs.Additionally,it assessed the contribution of each expenditure category to total hospital costs and performed cross-group comparisons using the non-parametric Kruskal–Wallis test.This study used the Steel–Dwass test for post-hoc multiple comparisons and the Spearman correlation coefficient to examine the relationships between variables.RESULTS The study found that in HB11 and HB13,the total hospitalization costs were significantly higher for pancreaticoduodenectomy than for pancreatectomy and hepatectomy.Although no significant difference was observed in the length of hospital stay between patients who underwent pancreaticoduodenectomy and pancreatectomy,both were significantly longer than those who underwent liver resection.In HB15,no significant difference was observed in the total cost of hospitalization between pancreaticoduodenectomy and pancreatectomy;however,both were significantly higher than those in hepatectomy.Additionally,the length of hospital stay was significantly longer for patients who underwent pancreaticoduodenectomy than for those who underwent pancreatectomy or liver resection.CONCLUSION China Healthcare Security Diagnosis Related Groups payment system positively impacts liver and pancreatic cancer surgeries by improving medical quality and controlling costs.Further research could refine this grouping system and ensure continuous effectiveness and sustainability.
基金supported in part by the Program of Improving Health Services in China’s Rural Areas supported by the World Bank Loans(Qinghai Province,QHWST-2009KT01).
文摘China has been undertaking a profound reform on health care.Although more than 1.16 billion people have been covered by rural and urban medical insurance to date,the level of reimbursement from insurance is very limited,especially for critical diseases such as leukemia.This places heavy economic burdens on patients.Under these circumstances,systems innovation is imperative for the efficient utilization of limited funding.In this respect,certain valuable experience from other countries may prove helpful.The prospective payment system of Diagnosis-related Groups(DRGs),Clinical Paths,and the Comparative Effectiveness Analysis adopted by the National Institute of Health and Clinical Excellence(NICE,UK),can befine tools to reduce medical costs and improve quality of services.Treatments of acute promyelocytic leukemia at Rui-Jin Hospital,and childhood acute lymphoblastic leukemia at Shanghai Children’s Medical Center,can be taken as suitable models to illustrate the crucial role of Clinical Paths in guaranteeing clinical and cost effectiveness of medical services for critical diseases,and to satisfactorily justify the feasibility of DRGs in China.
文摘Objective To study the successful experience of implementing diagnosis related group(DRG)payment system in the United States and provide a reference for China’s reform of health insurance payment.Since the United States is the first country to develop and apply the DRG in the world,its research and practice of DRG are always at the forefront.Methods Literature research method was used to investigate DRG payment system,the specific steps of the payment,the setting method of relevant indicators,and the quality supervision measures.Results and Conclusion There are mainly three aspects from the experience of DRG payment system in the United States.Firstly,the government’s responsibility for health insurance is clarified.Secondly,the relevant indexes are set reasonably.Thirdly,the DRG weight and base rate are adjusted dynamically to ensure the fairness of DRG payment.Therefore,China should pay attention to the following three aspects:clarifying the main responsibility of the government in the reform of health insurance payment,establishing the quality control system of the first page of medical records,and improving the supervision mechanism for medical quality.
基金General Projects of Social Science Planning Fund of Liaoning Province(L19BGL034)Shenyang Philosophy and Social Science Planning Fund Project(SZ202001L)Key Projects of Shenyang Social Science Fund(SYSK2020-04-01).
文摘Objective To implement the national diagnosis related group(DRG)policy smoothly,and gradually move towards value medicine and fine management,some suggestions are put forward for improving medical service efficiency,saving medical insurance fund,and reducing the burden of patients,so as to realize the win-win situation of medical insurance and patients.Methods Based on the experience of the United States,Australia,and Germany,the policy implementation background and development process in China were summarized.The advantages and disadvantages of single disease payment method,disease score payment method,and diagnosis related groups-prospective payment system(DRG-PPS)method were compared,and then the problems were found out.Results and Conclusion In view of the imperfect information system,lack of professional talents,and uneven progress of each pilot,it is proposed that relevant departments should pay more attention to the construction and improvement of coding and other information systems,cultivate professional talents,promote the reform of DRG payment technology specification and grouping technology combined with national pilot project,thus enhancing the application and in-depth development of DRG policy in China.
文摘本文阐述了病案管理在疾病诊断相关分组(Diagnosis Related Groups,DRG)支付体系中的重要性,包括病案信息的准确性和完整性对病种分组和支付标准的影响。分析了当前病案管理存在的问题,如病案质量不高、病案编码不规范、病案数据利用不足等。针对这些问题,本文提出了一系列病案管理优化策略,包括完善病案信息收集和整理流程、加强对病案信息收集和整理人员的培训、建立病案质量控制机制等。本文还讨论了病案管理策略优化在DRG支付体系中的意义与价值以及未来研究方向。
文摘2024年7月,国家医保局发布《关于印发按病组和病种分值付费2.0版分组方案并深入推进相关工作的通知》,标志着我国疾病诊断相关分组(diagnosis related group,DRG)支付改革正式迈入2.0时代。2.0版分组方案中,DRG增加了6组,核心DRG增加了33组,具有分组更科学合理、更契合临床实际情况的特点。国家医保局同步明确了5个配套管理机制,即特例单议机制、基金预付机制、谈判协商机制、意见收集反馈机制和数据公开机制,旨在优化DRG支付改革管理,确保医疗机构、医保部门和患者实现多方共赢。2.0版的发布,为医疗机构提供了更精细化的管理工具和更合理的支付机制。医疗机构应积极拥抱该项改革,通过优化内部管理和提高服务质量,实现成本控制和效率提升,最终达到患者、医保基金和医疗机构三方共赢。
