某三甲医院实施DRG付费对医院病种付费的影响  

Impact of DRG-based payment on payment for different disease types in a tertiary hospital

作　　者：申琪 徐静静 赵林玉 张健[1] 张磊[1] 张甄[1] SHEN Qi;XU Jingjing;ZHAO Linyu;ZHANG Jian;ZHANG Lei;ZHANG Zhen(Chenzhou No.1 People’s Hospital,Chenzhou 423099,China;Chenzhou Municipal Health Commision,Chenzhou 423699,China)

机构地区：[1]郴州市第一人民医院,湖南郴州423099 [2]郴州市卫生健康委,湖南郴州423699

出　　处：《现代医院》2022年第8期1224-1227,1231,共5页Modern Hospitals

基　　金：湖南省卫生健康经济管理科研重点指导计划项目(hnwsjkjg2020008)。

摘　　要：目的对按某三甲医院项目付费和单病种付费(DRG付费)的患者平均住院时间、住院医疗费用及费用结构进行分析,为医保支付改革和医院运营管理提供参考。方法以某三甲医院老年性白内障、甲状腺恶性肿瘤和不稳定型心绞痛3个病种为研究分析对象,将3个病种按DRG付费的患者分为DRG组,按项目付费的患者分为传统组,分析3个病种2种付费方式在平均住院时间、平均住院费用与医疗费用结构等方面的差异,了解2种付费方式的具体情况及影响。结果老年性白内障DRG组平均费用为5987.48元,住院时间和医疗总费用均低于传统组(P<0.001);甲状腺恶性肿瘤DRG组平均费用为12599.47元,医疗总费用低于传统组(P<0.001),住院时间无统计学意义(P>0.05);不稳定型心绞痛DRG组平均费用为11972.42元,医疗总费用和住院时间高于传统组(P<0.001)。结论DRG付费方式对常见病种诊疗费用控制及提升服务效率具有积极意义,对急危重症疾病则应建立动态DRG付费标准并进行定期评估,强化政策引导和监管。Objective To compare the average length of stay,hospitalization expenses and cost structure between item-based payment and diagnosis related groups(DRG)based payment,so as to provide a reference for medical insurance payment reform and operation and management of hospitals.Methods The payments for three diseases(senile cataract,thyroid malignancy and unstable angina pectoris)were analyzed in a tertiary hospital.The patients with the three diseases were randomly divided into traditional group,where the item-based payment was done,and DRG group,where DRG-based payment were used.The differences of the average length of stay,average hospitalization expenses and cost structure in each disease were analyzed between the two payments,and the specific situation and impact of the two payments were analyzed.Results The average cost of senile cataract patients in the DRG group was 5987.48 yuan,and the length of stay and total medical cost were significantly lower than those in the traditional group(P<0.001).The average cost of thyroid malignancy patients in the DRG group was 12599.47 yuan,and total medical cost were lower traditional group(P<0.001)and the length of hospital stay was not statistically significant(P>0.05);The average cost of unstable angina pectoris DRG group was 11972.42 yuan,the total medical cost and the length of hospital stay was higher than that of traditional group(P<0.001).Conclusion DRG-based payment has a positive significance for the control of the diagnosis and treatment fees of common diseases and on service efficiency.For acute and critical diseases,dynamic DRG-based payment standards should be established and regularly evaluated,and policy guidance and supervision should be strengthened.

关 键 词：项目付费 DRG付费 住院费用 老年性白内障 甲状腺恶性肿瘤 不稳定型心绞痛 

分 类 号：R197.32[医药卫生—卫生事业管理]