单病种定额付费住院费用分析  

Analysis of Hospitalization Expense Quota Payment of Single Disease

作　　者：戚苗苗 陈海云 高晶 谢青 陈顺丽 陈琳 QI Miaomiao;CHEN Haiyun;GAO Jing;XIE Qing;CHEN Shunli;CHEN Lin(Medical Insurance Of?fice,General Hospital of Eastern Theater Command,Nanjing 210002)

机构地区：[1]东部战区总医院医保办,南京210002

出　　处：《解放军医院管理杂志》2019年第3期257-260,共4页Hospital Administration Journal of Chinese People's Liberation Army

基　　金：江苏省医学人文社会科学基金课题资助(JSYRKJ2014-B1-02)

摘　　要：目的通过对单病种白内障手术费用的实证研究和影响分析,为单病种定额付费科学制定和动态调整提供参考。方法收集某三甲医院2014—2017年实施白内障手术的住院患者为研究对象,将2014—2015年定为单病种实施前组,2016—2017年定为单病种实施后组。采用描述统计学方法对单病种实施前后住院费用进行对比。结果实施单病种定额付费后,医院缩短平均住院日,加强信息化建设,控制不合理用药和诊疗管理等措施,使各项住院指标明显下降。平均住院费用由实施前的8 942.3元下降至实施后的7 154.5元,平均住院日由实施前的4.77天下降至实施后的2.59天,人均个人负担由3 733.2元下降至3 204.4元。结论建议加强单病种政策宣传,完善单病种付费机制和动态调整机制,使单病种结算更为合理,为进一步推动按C-DRG付费奠定基础。Objective To formulate single disease quota scientifically and provide reference for dynamic regulation.Through empirical research and impact analysis of single disease cataract surgery cost.Methods Inpatients that have done cataract surgery during 2014-2017 in a Grade Ⅲ Class A hospital were collected as research object,and those during 2014-2015 were grouped as single disease former group and during 2016-2017 were grouped as the later group.We adopted descriptive statistics to compare the hospitalization expenses of single disease of the former group and the later group.Results After the implementation of single disease quota payment,the hospital shortened the average hospitalization day,strengthened information construction,controlled irrational drug use and diagnosis treatment management.As a result,all kinds of indicators lowered significantly.The average hospitalization expenses declined from 8942.3 yuan to 7154.5 yuan before and after implementation.The average days of hospitalization declined from 4.77 days to 2.59 days before and after implementation.The individual burden per capita dropped from 3733.2 yuan to 3204.4 yuan.Conclusion It is suggested to reinforce the publicity of single disease policy and complete single-disease payment and dynamic adjustment mechanism,to make the single disease settlement more reasonable,and lay a foundation for further promoting the C-DRG.

关 键 词：单病种 定额付费 住院费用 

分 类 号：R197.32[医药卫生—卫生事业管理]