DRG支付下典型病组的低码高编和医疗资源消耗分析  

Analysis of Upcoding and Medical Resource Consumption of Typical Disease Groups Under DRG Payment

作　　者：方金鸣 刘玲[3] 彭义香 陶红兵[2] FANG Jin-ming;LIU Ling;PENG Yi-xiang;TAO Hong-bing(The Fourth Hospital of Wuhan.Pu Ai Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan Hubei 430033,China;不详)

机构地区：[1]武汉市第四医院·华中科技大学同济医学院附属普爱医院,湖北武汉430033 [2]华中科技大学同济医学院医药卫生管理学院,湖北武汉430030 [3]武汉市中心医院,湖北武汉430014

出　　处：《卫生经济研究》2022年第4期33-36,共4页

摘　　要：目的:分析DRG支付下典型病组的低码高编和医疗资源消耗情况。方法:以我国某DRG付费国家试点城市为例,实证分析典型病组患者构成比和医疗资源消耗情况。结果:DRG支付改革后,典型病组的重症患者显著增多、轻症患者显著减少,存在低码高编情况(P<0.001),医疗资源消耗降低(P<0.05),但医务人员劳务费用普遍降低。结论:低码高编是DRG改革的重点督查方向,要严格鉴别医疗资源消耗的减少是否正常,打击不正当缩减医疗资源消耗的行为,体现医务人员的劳动价值,保障参保患者的利益。Objective To analyze the upcoding and medical resource consumption of typical disease groups under DRG payment. Methods Taking a pilot city under DRG payment as an example, this study analyzed the patient composition ratio and medical resource consumption of typical disease groups. Results After the DRG payment reform, the number of severe patients in the typical disease group was significantly increased, and the number of mild patients was significantly decreased. Upcoding existed(P<0.001), and the consumption of medical resources was reduced(P<0.05). However, but the labor costs of medical staff were common reduced. Conclusion Upcoding is the key supervision direction of DRG reform. It is necessary to strictly identify whether the reduction of medical resource consumption is normal, crack down on improper reduction of medical resource consumption, show respect to labor value, and protect the interests of insurance beneficiaries.

关 键 词：DRG 医保支付改革 低码高编 资源消耗 

分 类 号：F840.684[经济管理—保险] R197[医药卫生—卫生事业管理]