北京市医药分开综合改革对某三甲医院DRG结算病例的费用影响分析  

Analysis on the Impact of Comprehensive Reform of Separation of Medical Treatment and Drug Sales on the Case Cost Cleared by DRG System in a Grade-A Tertiary Hospital in Beijing

作　　者：魏俊丽[1] 孙晶晶[1] 万昊[1] 李昕 WEI Junli(Beijing Friendship Hospital of Capital Medical University,Beijing,100050,China)

机构地区：[1]首都医科大学附属北京友谊医院,北京100050

出　　处：《医学与社会》2021年第7期89-92,112,共5页Medicine and Society

摘　　要：目的:明确北京市医药分开综合改革对医疗机构费用调控的影响,为医保政策调整及医疗机构管理提出建议。方法:对某三甲医院2016-2018年按疾病诊断相关分组付费结算病例费用总体、科室、病种的基金支付、患者支付、医院盈亏等数据进行统计分析。结果:108组DRG结算病例的例均基金支付下降,例均患者支付增加;监护及辅助呼吸设备费、放射费、一般检查费、药品费用、输血费改革后明显低于改革前,护理费和医用耗材费改革后明显高于改革前;费用支付构成发现除肝病、口腔、消化各项没有差异外,其他科室各项均有差异。结论:费用结构变化整体稳定。价格调整应建立周期性调整机制,并完善配套支付政策。Objective:To evaluate the impact of comprehensive reform of separation of medical treatment and drug sales on the cost control of medical institutions in Beijing,so as to put forward suggestions for the adjustment of medical insurance policies and the management of medical institutions.Methods:Statistical analysis was conducted on the data of total cost cleared by the DRG system,cost by department,cost paid by insurance fund,cost paid by the patient,and balance of hospital from 2016 to 2018 in a Grade-A tertiary hospital.Results:Average case cost of fund payment of 108 DRG payment cases decreased while the average case cost paid by patients increased.The cost of monitoring and auxiliary respiratory equipment,radiation,general medical check,medicine and blood transfusion was significantly lower after the reform.The cost of nursing and medical consumables was significantly higher after the reform.Cost payment constitution exhibited significant changes for all departments after the reform,except for the liver disease department,oral department and digestion department.Conclusion:The changes of the cost constitution are stable on the whole.A periodical price adjustment mechanism should be established and the complementary payment policy should be improved.

关 键 词：医药分开 按疾病诊断相关分组 费用 

分 类 号：R195[医药卫生—卫生统计学]