DRG付费法下晶体手术组盈亏的影响因素分析  

Analysis of Influencing Factors of Surplus for Crystal Surgery Group Under DRG Payment Method

作　　者：陶洋 王芳芳[1] 朱晨晨 张丽梅 TAO Yang;WANG Fang-fang;ZHU Chen-chen;ZHANG Li-mei(Department of Medical Record Statistics,The Affiliated People's Hospital of Ningbo University,Ningbo 315000,Zhejiang,China)

机构地区：[1]宁波大学附属人民医院病案统计室,浙江宁波315000

出　　处：《医学信息》2022年第11期5-7,共3页Journal of Medical Information

摘　　要：目的探讨宁波某院影响晶体手术疾病诊断相关分组(DRG)盈亏的相关因素。方法根据宁波市某院2021年1月-6月医保DRG系统的分组结果,收集1383例晶体手术的住院病例的病案首页信息,将其根据医保盈余情况分为盈余组(629例)与亏损组(754例),使用单因素和多因素线性回归方法分析住院病例特点及分项费用与医保盈余的相关性。结果盈余组与亏损组的年龄、术前住院天数、住院天数、性别比较,差异无统计学意义(P>0.05);两组的手术分期及诊疗组的分布比较,差异有统计学意义(P<0.05);分项费用中住院费用明细中治疗费、西药费、耗材费与盈余额呈负相关,其他费用与盈余额呈微弱正相关(P<0.05);经多元线性回归构建的盈余模型:盈余额度=7318.779-1.038×综合服务费-1.017×诊断费-1.025×治疗费-0.243×西药费-1.005×耗材费,标准化各单项费用后,耗材费对盈余额度的影响最大。结论降低单眼晶体手术DRG组费用的关键在于加强耗材管理,合理控制耗材费用。Objective To explore the related factors affecting the surplus for crystal surgery of diagnosis related groups(DRG)in a hospital in Ningbo.Methods According to the grouping results of medical insurance DRG system in a hospital in Ningbo from January to June 2021,the first page information of medical records of 1383 hospitalized patients with crystal surgery was collected.And according to the medical insurance surplus,they were divided into surplus group(629 cases)and deficit group(754 cases).Single factor and multi-factor linear regression methods were used to analyze the correlation between the characteristics of hospitalized patients and the sub-cost of medical insurance surplus.Results There were no significant differences between the surplus group and the deficit group in age,preoperative hospitalization days,hospitalization days and gender(P>0.05),whereas there were statistically significant differences in surgical stages and distribution of the diagnosis and treatment group(P<0.05).In the details of hospitalization expenses,treatment expenses,medicine expenses and consumables expenses were negatively correlated with the surplus balance,while other expenses were slightly positively correlated with the surplus balance(P<0.05).The surplus model constructed by multiple linear regression was as follows:surplus amount=7318.779-1.038×comprehensive service expenses-1.017×diagnosis expenses-1.025×treatment expenses-0.243×medicine expenses-1.005×consumables expenses.After standardizing details of expenses,consumables expenses had the greatest influence on surplus amount.Conclusion The key to reduce the cost of DRG is to strengthen the management of consumables and rationally control the cost of consumables.

关 键 词：疾病诊断相关分组 点数法付费 晶体手术 盈亏分析 

分 类 号：R197[医药卫生—卫生事业管理]