南京市某医院乳腺癌根治手术在DRG支付方式下超支结余分析  

Cause Analysis and Countermeasures of Overspending Balance of Radical Operation for Breast Cancer under DRGPayment in a Certain Hospital in Nanjing

作　　者：徐凌康 王滢鹏 万彬[1] 陈大伟[1] 占伊扬[1] 丁海霞[1] XU Lingkang;Wang Yingpeng;Wan Bin;CHEN Dawei;ZHAN Yiyang;DING Haixia(Medical Insurance Office,Jiangsu Province People’s Hospital,Nanjing,Jiangsu,210000)

机构地区：[1]江苏省人民医院医疗保险处,江苏南京210000

出　　处：《江苏卫生事业管理》2023年第7期936-940,共5页Jiangsu Health System Management

摘　　要：目的:通过研究DRG医保支付方式背景下,南京市某医院乳腺外科A、B两个诊疗组开展乳房恶性肿瘤根治性切除术(JA2组)的医疗费用差异,探讨超支结余的产生原因并总结可行性解决方案。方法:统计患者医保费用结算清单数据,分析南京市某医院A、B两个诊疗组开展JA2组的住院患者费用相关指标的差异。结果:病种组费用结构对医疗费用管理产生重要影响。A、B两个诊疗组JA2组住院患者的医疗总费用、DRG超支结余、耗材费、药品费等均具有显著性差异。结论:优化病种组结构,在保证医疗水平的基础上,强化医保费用管理意识,确保药品、耗材、检查项目合理使用,DRG医保支付方式可以有效控制乳腺癌根治手术的医疗费用。Objective:By studying the difference in medical expenses of radical mastectomy for malignant breast tumors(JA2 group)conducted by two treatment groups A and B of a certain hospital in Nanjing under the background of DRG medical insurance payment method,this study explores the reasons for excess expenditure and summarizes feasible solutions.Method:By collecting data from the medical insurance expense settlement list of patients,to analyze the differences in cost related indicators of inpatients undergoing radi-cal mastectomy for malignant tumors(JA2 group)in A and B groups of a certain hospital in Nanjing.Result:The cost structure of dis-ease groups has a significant impact on medical expense management.There were significant differences in the total medical expenses,DRG overspending balance,consumables costs,and drug costs of hospitalized patients in the JA2 group of two diagnosis and treatment groups B.Conclusion:Optimize the structure of disease groups,strengthen the awareness of medical insurance expense management,and ensure the rational use of drugs,consumables,and inspection items on the basis of ensuring the medical level.DRG medical insur-ance payment can effectively control the medical expenses of breast cancer radical surgery.

关 键 词：DRG 医保支付 乳腺癌根治手术 超支结余 

分 类 号：R197.1[医药卫生—卫生事业管理]