目的分析疾病诊断相关分组(diagnosis related groups,DRG)高倍率病例费用结构,研究影响住院费用的相关因素,合理利用DRG评价指标,为公立医院精细化管理和高质量发展提供参考。方法以2021年1月—2022年6月广西某三甲医院为样本,描述分...目的分析疾病诊断相关分组(diagnosis related groups,DRG)高倍率病例费用结构,研究影响住院费用的相关因素,合理利用DRG评价指标,为公立医院精细化管理和高质量发展提供参考。方法以2021年1月—2022年6月广西某三甲医院为样本,描述分析高倍率病例特征,运用SPSS 26.0统计学分析各因素对费用的影响。结果数据来源为从医保平台选取2021年1月—2022年6月DRG终审数据,高倍率病例6217例,占比5.76%,内科组与外科组在高倍率病例占比比较,差异无统计学意义(P>0.05)。在单因素分析中,权重、科室类别对高倍率病例住院费用有显著影响(P<0.05),而医保类别与高倍率费用无关(P>0.05)。结论权重递增结合费用倍数递减的方式制定高倍率病例认定标准是相对科学合理的,但同时应加大对违规入组病例审核力度,重视目前实际付费阶段存在的问题,转变传统医保按项目付费观念,多种付费方式相结合,合理利用DRG评价指标,以更好适应DRG支付方式改革。展开更多
Background：The study was to explore the causes of high inpatient expenditure through analyzing the distribution characteristics as well as the influence factors of high inpatient expenditure cases during 3 years with...Background：The study was to explore the causes of high inpatient expenditure through analyzing the distribution characteristics as well as the influence factors of high inpatient expenditure cases during 3 years within a Grade-A tertiary hospital through various aspects and multiple angles,thus identifying the major influence factors for high medical expenditure to develop further research.Methods：We retrospectively studied 204l inpatient cases which cost more than RMB 100,000 Yuan per case in a Grade-A tertiary hospital from 2013 to 2015.We analyzed the compositions of the medical cost to evaluate the major factors that cause the high inpatient expenditure.All the data and materials were collected from medical record system,and the statistical methods included t-test,variance of analysis,and multivariate linear regression.Results：The average cost of the 2,041 cases was RMB 152,173 Yuan for medicines and materials of medical costs,which respectively accounted for 33.03% and 32.32% of the total cost;and the average length of hospital stay was 28.39 days/person.Diseases of skeletal and muscular system,circulatory system,and tumor were the top three disease categories of high inpatient expenditure,which accounted for 39.00%,33.46%,and 18.03%,respectively.Complications,criticality of the disease,gender of the patients,the occurrence of death,and the excessive length of hospital stay all had great impacts on average medical expenditure,while age,hospital infection,and surgery showed no significant impact on average medical cost.Conclusions：The main factors for high inpatient expenditure included the inadequate use of high-value medicines and materials,lacking cost control measures within the hospital,the excessive length of hospital stay for inpatients,and the unnecessary treatment for the patients.展开更多
文摘目的分析疾病诊断相关分组(diagnosis related groups,DRG)高倍率病例费用结构,研究影响住院费用的相关因素,合理利用DRG评价指标,为公立医院精细化管理和高质量发展提供参考。方法以2021年1月—2022年6月广西某三甲医院为样本,描述分析高倍率病例特征,运用SPSS 26.0统计学分析各因素对费用的影响。结果数据来源为从医保平台选取2021年1月—2022年6月DRG终审数据,高倍率病例6217例,占比5.76%,内科组与外科组在高倍率病例占比比较,差异无统计学意义(P>0.05)。在单因素分析中,权重、科室类别对高倍率病例住院费用有显著影响(P<0.05),而医保类别与高倍率费用无关(P>0.05)。结论权重递增结合费用倍数递减的方式制定高倍率病例认定标准是相对科学合理的,但同时应加大对违规入组病例审核力度,重视目前实际付费阶段存在的问题,转变传统医保按项目付费观念,多种付费方式相结合,合理利用DRG评价指标,以更好适应DRG支付方式改革。
文摘Background：The study was to explore the causes of high inpatient expenditure through analyzing the distribution characteristics as well as the influence factors of high inpatient expenditure cases during 3 years within a Grade-A tertiary hospital through various aspects and multiple angles,thus identifying the major influence factors for high medical expenditure to develop further research.Methods：We retrospectively studied 204l inpatient cases which cost more than RMB 100,000 Yuan per case in a Grade-A tertiary hospital from 2013 to 2015.We analyzed the compositions of the medical cost to evaluate the major factors that cause the high inpatient expenditure.All the data and materials were collected from medical record system,and the statistical methods included t-test,variance of analysis,and multivariate linear regression.Results：The average cost of the 2,041 cases was RMB 152,173 Yuan for medicines and materials of medical costs,which respectively accounted for 33.03% and 32.32% of the total cost;and the average length of hospital stay was 28.39 days/person.Diseases of skeletal and muscular system,circulatory system,and tumor were the top three disease categories of high inpatient expenditure,which accounted for 39.00%,33.46%,and 18.03%,respectively.Complications,criticality of the disease,gender of the patients,the occurrence of death,and the excessive length of hospital stay all had great impacts on average medical expenditure,while age,hospital infection,and surgery showed no significant impact on average medical cost.Conclusions：The main factors for high inpatient expenditure included the inadequate use of high-value medicines and materials,lacking cost control measures within the hospital,the excessive length of hospital stay for inpatients,and the unnecessary treatment for the patients.
