基于DRG的某院住院患者费用超标原因分析:以FC35病组为例  

Analysis on the causes of excessive expenses of inpatients based on DRG:a case study of FC35 disease group

作　　者：陈颖[1] 孔晴宇[1] 张朦朦 孙蕾[1] Chen Ying;Kong Qingyu;Zhang Mengmeng;Sun Lei(Medical Insurance Office,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院医疗保险办公室,北京100029

出　　处：《中华医院管理杂志》2021年第12期1018-1021,共4页Chinese Journal of Hospital Administration

摘　　要：目的对医院DRG病组费用超标原因进行研究,探索对DRG病组费用的分段管理。方法以FC35病组(冠状动脉搭桥,不伴合并症与伴随病)为例,选取某院2019年6—12月的1416例FC35病组出院患者,以北京市2019年三级综合医院该病组的次均费用为标杆值,将其分为费用超标患者和未超标患者。对两组患者住院费用进行对比分析、患者医嘱数据的科室间横向比较和患者费用分段统计。结果1416例FC35病组患者中614例(43.36%)的住院费用超标;B科室、D科室和E科室的病例数最多且整体费用效率较好;手术室和麻醉科的费用占患者总费用的52.77%;手术室内高值管、高值线、高值其他、补片以及卫生材料的次均费用位于前5位。结论手术室高值耗材费用是导致某院FC35病组患者费用超标的重要原因之一。Objective To study the reasons of excessive expenses in hospital and explore the segmented management of the cost of DRG group.Methods Taking the FC35(coronary artery bypass grafting,without complications and comorbidities)as an example,1416 patients of FC35 group discharged from the hospital from June to December 2019 were selected.Taking the average cost of the disease group in the tertiary general hospitals of Beijing in 2019 as the benchmark value,the patients were divided into patients with excessive cost and patients without excessive cost.The hospitalization expenses of the two groups were compared and analyzed,the horizontal comparison between departments and the segmented statistics of patients′expenses were conducted.Results In the FC35 group,614 patients(43.36%)had excessive hospitalization costs.Clinical departments B,D and E had the largest number of cases and the overall cost efficiency was better.Operating room and anesthesiology expenses accounted for 52.77%of the total cost of patients.The cost of high-value tube,high-value line,high-value other,mesh and sanitary materials in the operating room ranked in the top 5.Conclusions The cost of high value consumables in the operating room is one of the important reasons for the excessive cost of patients.

关 键 词：疾病诊断相关分组 住院费用 费用控制 冠状动脉搭桥术 

分 类 号：R197.32[医药卫生—卫生事业管理]