DRG背景下医药分开政策对新疆医疗服务绩效调控效果分析  

Analysis on the Regulatory Effect of Medical Separation Policy on Medical Service Performance in Xinjiang under the Background of DRG

作　　者：刘奎[1] 蒋莉[1] 魏绍明[1] 杨莹[1] 阎景红[2] 杨淑梅[1] 郭建新[1] LIU Kui;JIANG Li;WEI Shao-ming;YANG Shu-mei(The Fifth Affiliated Hospital of Xinjiang Medical University,Xinjiang,830011,China;不详)

机构地区：[1]新疆医科大学第五附属医院,乌鲁木齐830011 [2]新疆医科大学第一附属医院,乌鲁木齐830054

出　　处：《中国卫生经济》2020年第11期15-19,共5页Chinese Health Economics

基　　金：新疆维吾尔自治区自然科学基金项目(2018D01C303)。

摘　　要：目的:从DRG角度审视医药分开政策对绩效带来的影响,为按病种付费及医疗卫生改革提供理论支持。方法:使用DRG为风险调整工具,对2016—2019年7所医院服务绩效进行分析与评价,采用SPSS 16.0进行统计分析,统计方法包括:一般性统计描述、Z检验、t检验、加权秩和比,数据库软件有SQL Server 2008和Oracle。结果:政策实施后总权重增加了43240.18,DRG组数增加了22,CMI降低了0.01,MDC降低了1,平均费用增长了1140.10元、医技费增长了252.74元、平均药费降低了1530.59元。结论:新疆地区不同隶属关系的卫生机构费用构成差异逐渐减小,基本趋于平衡;药品费用降低带来了更好的患者就诊体验;绩效产出、病案首页质量填写有所提升;需要重视费用结构调整带来的DRG评价功能降低现象。Objective:To examine the impact of the separation of medicines policy on performance from the perspective of DRG,and provide theoretical support for payment by disease and medical and health reform.Methods:Using DRG as a risk adjustment tool to analyze and evaluate the service performance of 7 hospitals from 2016 to 2019.SPSS 16.0 was applied for statistical analysis.Statistical methods include general statistical description,Z test,t test,and weighted rank sum ratio.Database software includes SQL Server 2008 and Oracle.Results:After implementation,the total weight increased by 43240.18,the number of DRG groups increased by 22,CMI decreased by 0.01,and MDC decreased by 1.The average cost increased by 1140.10 yuan,the medical technology cost increased by 252.74 yuan,and the average drug cost decreased by 1530.59 yuan.Conclusion:In Xinjiang,the differences in the cost composition of health institutions with different affiliations are gradually decreasing,which tends to be basically balanced;the decrease in drug cost brings better patient experience,and the performance output and the quality of the front page of medical records are improved;attention should be paid to the decrease in DRG evaluation function caused by the adjustment of cost structure.

关 键 词：医药分开 绩效管理 疾病相关诊断分组 新疆 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] R19-0