北京市DRGs试点效果评价  

Evaluation on the Effect of DRGs Pilot Project in Beijing

作　　者：王沛陵[1] 郑杰 贾方红 吴曼 王娟 段小宛 WANG Peiling;ZHENG Jie;JIA Fanghong(Wouan Hospital,Capital Medical University,Beijing,100069,China)

机构地区：[1]首都医科大学附属北京佑安医院,北京100069 [2]北京医疗保险事务管理中心,北京100050 [3]北京卫生经济研究学会,北京100053

出　　处：《中国社会医学杂志》2018年第5期535-538,共4页Chinese Journal of Social Medicine

基　　金：北京市属医院科研培育计划项目(PG2018028)

摘　　要：目的回顾性分析北京市诊断相关分组付费政策执行情况,为付费制度改革提供建议。方法通过对疾病诊断相关分组(diagnosis related groups,DRGs)试点医院运行指标分析,评价DRGs运行现状;通过比较试点医院和非试点医院医疗难度系数(CMI)、时间消耗变异率、费用消耗变异率、两周再住院率等指标,分析DRGs政策对于医院运行效率和治疗效果的影响。结果试点医院2014—2016年3年差额盈余率为9.95%,但盈余率逐年下降,患者负担率逐年上升;3年盈余率超过50%的DRGs有6组;3年亏损率超过10%的有7组;有部分DRGs组例数持续减少。Pearson相关分析结果显示,医院盈余下降与患者个人负担增长呈负相关,线性回归分析结果表明,试点医院对于DRGs的结算和选择与DRGs盈余无关;试点医院对于医疗费用增长率控制、医疗效率和治疗效果均好于对照医院。结论 DRGs对促进医院的精细化管理、降耗提效作用明显,符合政策预期。在推进中,需要建立动态调标机制、监管机制、线外病例标准、医疗质量标准等配套政策,确保政策可持续发展。Objective To review and analyze the implementation of Diagnosis-related groups（DRGs）policy in Beijing,and provide suggestions for the reform of the payment system.Methods By analyzing the operating index of DRGs pilot hospitals to evaluate the current operating situation of DRGs.By comparison of the CMI,the mutation rate of hospitalization,the mutation rate of hospital cost growth,hospitalization rate in two weeks among DRGs pilot hospitals and non-pilot hospitals to analyze the impact of DRGs policy on the effect of the operational efficiency and treatment effects of medical institutions.Results The three-year surplus rate in the pilot hospitals was 9.95%,but the surplus rate dropped year by year and meanwhile,the patient burden rate increased year by year.There were 6 DRGs with the surpassed 50% surplus rate in three years and 7 groups with the loss rate exceeded 10% in three years.The number of cases continued to decrease in some of the DRGs.Person correlation analysis showed that the settlement and selection of DRGs by pilot hospitals had nothing to do with the DRGs＇ surpluses.The pilot hospitals had better control over the growth rate of medical expenses,the medical efficiency and the treatment effect than the control hospitals.Conclusion DRGs plays an important role in promoting the fine management,reducing consumption and improving the efficiency of medical institutions,and is in line with the policy expectation.In the process of promotion,we need to establish a dynamic adjustment mechanism,supervision mechanism,out of line case standards,medical quality standards and other supporting policies to ensure the sustainable development of policies.

关 键 词：疾病诊断相关分组 试点效果 按病种付费 

分 类 号：R197.1[医药卫生—卫生事业管理]