新农合DRG支付方式改革对肌肉骨骼系统疾病病组结构的影响  

Impact of DRG Payment Method Reform of New Rural Cooperative Medical System on Disease Group Structure of Musculoskeletal System Diseases

作　　者：郭在新 李璟媛 冯文[1] GUO Zaixin(School of Public Health,Peking University,Beijing,100191,China)

机构地区：[1]北京大学公共卫生学院,北京100191

出　　处：《医学与社会》2022年第8期89-93,共5页Medicine and Society

摘　　要：目的:分析DRG支付方式改革后肌肉、骨骼疾病及功能障碍(MDCI)病组患者数量及其结构的变化,探讨疾病的疑难程度、控费效果与患者结构变化的关系。方法:利用某市新农合DRG改革试点医院2016-2019年的MDCI出院患者数据,通过统计描述和中断时间序列分析改革前后二三级医院MDCI病例数、病例组合指数、次均费用的变化,通过多重线性回归分析权重和次均费用变化对患者结构的影响。结果:改革后二三级试点医院MDCI月度病例数涨势加快,病例组合指数分别由改革前的1.55、1.56增至2.13、2.31,次均费用涨幅超40%。多重线性回归分析结果显示权重、次均费用增量和二者的交互作用影响二级医院MDCI的患者结构变化(P<0.01),权重和次均费用增量影响三级医院MDCI的患者结构变化(P<0.05)。结论:DRG支付方式改革后,二三级医院MDCI患者数量及病例组合指数大幅上涨,医院控制成本的动力不足,高权重和存在费用上涨空间会使患者规模扩张的可能性增加。Objective:To analyze the changes in the number of patients and structure of musculoskeletal diseases and dysfunction(MDCI)after the DRG payment method reform,and to explore the relationship between the difficulty of diseases,the effect of cost control and the change of patient structure.Methods:Using the data of discharged patients with MDCI in pilot hospitals of DRG payment reform of new rural cooperative medical system in a city from 2016 to 2019,the statistical description and interrupted time series were applied to the analysis of the changes in the number of MDCI cases,case mix index(CMI)and the average cost of cases in secondary and tertiary hospitals before and after the reform.Then through multiple linear regression,the impact of relative weight(RW)and average cost changes on the structure of patients was analyzed.Results:After the reform,the monthly average number of MDCI cases in secondary and tertiary hospitals evidently increased.The CMI of secondary and tertiary hospitals increased from 1.55 and 1.56 before the reform to 2.13 and 2.31 respectively.The average cost for MDCI cases in secondary and tertiary hospitals increased by more than 40%.The results of multiple linear regression showed that RW,the difference of average cost and interaction of them had impacts on the structure of patients of MDCI in secondary hospitals(P<0.01),and RW and the difference of average cost had impacts on the structure of patients of MDCI in tertiary hospitals(P<0.05).Conclusion:After the reform of the DRG payment method,the number of MDCI cases and CMI in secondary and tertiary hospitals have risen sharply and hospitals are not motivated to control costs.High RW and the room of increasing medical costs will add to the possibility for hospitals to admit more patients.

关 键 词：DRG 支付方式改革 新农合 肌肉骨骼系统疾病 病组结构 

分 类 号：R195[医药卫生—卫生统计学]