DRG与DIP付费模式在缺血性心脏病患者医保支付费用差异与按项目付费费用中的差异  

The Difference of Medical Insurance Payment and Fee-for-service Payment in Patients with Ischemic Heart Disease between RG and DIP Payment Model

作　　者：郑文玲[1] 于明明 贾春惠 ZHENG Wenling;YU Mingming;JIA Chunhui(Medical Insurance Management Office,Weifang Hospital of Traditional Chinese Medicine,Weifang 261041,China;NO.1 Department of Cardiology,Weifang Traditional Chinese Medicine,Weifang 261041,China)

机构地区：[1]潍坊市中医院医保管理办公室,山东潍坊261041 [2]潍坊市中医院心内一科,山东潍坊261041

出　　处：《中国医药指南》2023年第21期107-109,共3页Guide of China Medicine

摘　　要：目的对比DRG与DIP付费模式在缺血性心脏病患者医保支付费用差异与按项目付费费用的差异。方法数据来源于潍坊市中医院心血管内科,选取2021年12月至2022年10月主要诊断为缺血性心脏病的全部出院病例(剔除因其他疾病治疗后转入心血管内科的病例)为研究对象。根据治疗方式可初步划分为无手术组41例、检查组17例和手术组28例。其中,检查组均为造影检查的患者,共1个亚组;手术组可分为冠状动脉内球囊扩张(PTCA)亚组2例、置入一根支架亚组20例、置入两根支架亚组4例、置入三根支架亚组2例,共4个亚组。对比各组及亚组例均费用,比较DRG支付费用与按项目付费费用,比较DIP支付费用与按项目付费费用,比较DRG与DIP支付费用。结果3组之间,诊断费和综合服务费差别较小,费用差异主要体现为药费、治疗费和耗材费;DRG支付在无手术组、检查组和手术组之间的支付费用差异显著,但在手术组亚组之间的支付无显著差异;DIP支付在无手术组、检查组和手术组之间支付费用差异较大,各个亚组之间的支付费用差异也明显,随着置入支架数量的增加,DIP支付费用逐步提高,与按项目付费的规则一致。相比于DRG付费,手术组不同亚组之间的DIP支付费用与按项目付费例均费用更接近;无手术组、造影检查亚组和置入一根支架亚组的DRG平均支付费用明显高于DIP平均支付费用。置入二根支架和置入三根支架亚组的DIP平均支付费用明显高于DRG平均支付费用。结论DRG与DIP的融合应用改革后,可合理控制住院费,使费用结构趋于合理。这是因为对患者的诊断与治疗方式是基于患者的病历资料制定的。对不必要住院、手术的患者而言,有助于节省检查、化验、药品、耗材费用上的支出。Objective To compare the difference between DRG and DIP payment mode between medical insurance payment and project-based payment in patients with ischemic heart disease.Methods The data were collected from the department of cardiology,Weifang Hospital of Traditional Chinese Medicine,and all the discharged cases with ischemic heart disease from December 2021 to October 2022 were selected(cases transferred to the department of cardiology after treatment of other diseases were excluded).According to the treatment mode,it can be preliminarily divided into 41 cases in the no-surgery group,17 cases in the examination group and 28 cases in the surgical group.Among them,the examination group was all patients with contrast examination,a total of 1 subgroup;The surgical group could be divided into 2 cases of intracoronary balloon dilation(PTCA),20 cases of one stent insertion,4 cases of two stent subgroup,and 2 cases of three stent subgroup,a total of 4 subgroups.Compare the average costs of each group and subgroup,compare DRG payment fees with project-based fees,compare DIP payment fees with project-paid fees,and compare DRG and DIP payment fees.Results Among the three groups,the difference between diagnosis fee and comprehensive service fee was small,and the difference in cost was mainly reflected in the cost of medicine,treatment and consumables.DRG payments differed significantly between no-surgical,examined,and surgical groups,but not between subgroups in the surgical group;The cost of DIP payment varied significantly between the no-operative group,the examination group and the surgical group,and the payment fee between the subgroups was also significant,and the cost of DIP gradually increased as the number of stent placements increased,consistent with the pay-per-project rule.Compared with DRG payment,the cost of DIP payment between different subgroups of the surgical group was closer to the average cost of per-project payment.The average cost of DRG in the nosurgery,contrast subgroup,and one-stent placement subgroup

关 键 词：疾病诊断相关分组 按病种分值付费 按项目付费费用 支付费用差异 

分 类 号：R5[医药卫生—内科学]