基于DRG支付的云南省定点医疗机构冠心病住院患者医疗费用分析  

Analysis of Medical Expenses of Inpatients with Coronary Heart Disease in Designated Medical Institutions in Yunnan Province Based on DRG Payment

作　　者：冯玉莹 蔡鑫宇 FENG Yuying(School of Management,Shanghai University of Engineering Science,Shanghai,201620,China)

机构地区：[1]上海工程技术大学管理学院,上海201620 [2]首都经济贸易大学劳动经济学院,北京100070

出　　处：《医学与社会》2021年第3期102-106,122,共6页Medicine and Society

基　　金：国家社会科学基金资助项目,编号为13BGL138。

摘　　要：目的:探索云南省定点医疗机构冠心病按DRG支付的实施效果,为云南省深化医改提供参考。方法:收集《云南省医疗保险基金管理中心关于2018年省本级城镇职工医疗保险住院医疗费用DRGs付费结算办法》规定的30家定点医疗机构2017年和2019年病案统计具有完整资料的出院患者中所有当次诊断为冠状动脉粥样硬化性心脏病的患者1870例,将患者资料作实验组和对照组的分类比较,利用三重差分法衡量DRG控制费用的效果。结果:定点医疗机构实验组中住院患者的医疗费用支付标准比对照组更加合理。对照组的医疗费用在医保基金支付、住院费用总额和个人负担费中相比于实验组的增幅分别为16.67%、13.79%、8.85%。DRG支付对住院费用总额、医保基金支付金额和个人负担费用影响程度依次为降幅16.30%、15.30%、15.80%。结论:基于DRG制定的医院费用支付标准更有合理性,使得诱导需求现象得到了一定程度的控制,可以为云南省深化医改提供一定的借鉴,但对医生的主动控费观念的影响有限,使药品费用的控费效果不佳,三医联动将发挥重要作用。Objective:To explore the implementation effect of DRG payment of coronary heart disease in designated medical institutions in Yunnan Province,so as to provide reference for deepening medical reform in Yunnan province.Methods:The medical record statistics of all discharged patients with complete data of the 30 designated medical institutions stipulated by Yunnan Provincial Medical Insurance Fund Management Center on the 2018 Provincial-level Urban Employees'Medical Insurance DRGs Payment Settlement Measures in 2017 and 2019 were collected.1870 patients diagnosed with coronary atherosclerotic heart disease for the first time were classified and compared between the experimental group and the control group,and the difference-in-difference-in-differences(DDD)used to measure the effect of DRG in cost control.Results:The payment standard for medical expenses of inpatients in the experimental group of designated medical institutions was more reasonable compared to the control group.The medical expenses of the control group increased by 16.67%,13.79%and 8.85%respectively in the payment of medical insurance fund,the total hospitalization expenses and the personal expenses than that of the experimental group.The total hospitalization expenses,medical insurance fund payment and personal expenses based on DRG payment decreased by 16.30%,15.30%and 15.80%.Conclusion:Hospital fee payment standards formulated based on DRG are more reasonable,achieving a certain degree of control of the induced demand phenomenon,which can provide a certain reference for the medical reform of Yunnan province.The fee control effect is not good,and the three medical linkages will play an important role.

关 键 词：住院费用 冠心病 疾病诊断相关分组 云南 

分 类 号：R197.3[医药卫生—卫生事业管理]