基于新灰色关联与结构变动度的DRG付费改革对冠心病患者次均住院费用影响  

Analysis of the Influence of DRG Payment Reform on the Average Hospitalization Expense of Patients with Coronary Heart Disease Based on the New Gray Correlation and Structural Variation Degree

作　　者：马宗奎 刘明孝 胡靖琛 陈永利[1] 沈波 贺华[1,2] Ma Zongkui;Liu Mingxiao;Hu Jingchen(Renmin Hospital of Wuhan University,Wuhan,Hubei,430060,China;不详)

机构地区：[1]武汉大学人民医院,湖北武汉430060 [2]武汉大学大数据健康医疗研究与应用中心,湖北武汉430060

出　　处：《中国医院管理》2022年第8期70-73,共4页Chinese Hospital Management

摘　　要：目的 了解按疾病诊断相关分组(Diagnosis Related Groups,DRG)付费改革后冠心病患者次均住院费用变化情况,探索费用变动的主要类别和变化方向,为有效控制住院费用、完善医保基金支付方案提供对策建议。方法 收集2018年、2019年和2020年7月—2021年6月湖北省某三级综合医院冠心病住院患者费用信息,运用新灰色关联与结构变动度分析法,研究住院费用内部结构变化以及相互间关联程度。结果 冠心病患者次均住院费用关联度排名前3位的是药品费、耗材费、诊断费。2018年、2019年和2020年7月—2021年6月住院均次费用结构变动度为14.74%,结构变动贡献率前3位的费用是药品费、耗材费、诊断费,累计贡献率为63.52%。药品费、治疗费、血费和血液制品费占比逐年下降,诊断费、手术治疗费占比逐年上升。结论 冠心病患者次均住院费用得到有效控制,费用结构趋于合理。诊断费、耗材费仍为影响次均住院费用的主要因素,体现医务人员劳动力价值的费用增幅有限。DRG付费成为控制医疗费用的有效手段,支付方案仍需继续优化。Objective To investigate the average hospitalization expense category and changes of patients with coronary heart disease after the Diagnosis Related Groups(DRG) payment reform,to provide countermeasures for effectively controlling the expense and improving the medical insurance fund payment initiative. Methods Data on the hospitalization expense of patients with coronary heart disease was collected in a grade-III territory general hospital in Hubei Province during 2018—2019 and July 2020—June 2021. The new gray correlation and degree of structural variation were used to analyze the structural changes and mutual relationship of the average hospitalization expense.Results The top three associated factors were the expense of drugs,consumables,and diagnosis. The structural variation degree of the average hospitalization expense during 2018—2019 and July 2020—June 2021 was 14.74%.The top three factors affecting the contribution rate of structural change were the cost of drugs,consumables,and diagnostics. The cumulative contribution rate of these three factors was 63.52%. The expenditure proportion of drug,treatment,blood,and blood product was decreasing year by year,while diagnosis and surgical treatment were increasing yearly. Conclusion The average hospitalization expense of inpatients with coronary heart disease had been effectively controlled,and the expense structure tends to be more reasonable. The expense of diagnosis and consumables had become the main factors affecting the average hospitalization expense, while the expense increase which reflects the labor value of medical staff is limited. DRG payment had become an effective measure to control medical expenses. The payment initiative still needs to be optimized.

关 键 词：DRG付费 新灰色关联结构变动度 冠心病 次均住院费用 

分 类 号：R197.322[医药卫生—卫生事业管理]