DRG支付方式改革下的病组拨付差额分析  

Analysis of the appropriations balance of disease groups under DRG payment reform

作　　者：周道亮 ZHOU Daoliang(Health Community Group of Yuhuan People’s Hospital,Taizhou 317600,China)

机构地区：[1]玉环市人民医院健共体集团,浙江台州317600

出　　处：《现代医院》2023年第8期1234-1236,共3页Modern Hospitals

基　　金：浙江省医院协会课题(2021ZHA-YZJ216)。

摘　　要：目的通过分析在DRG支付方式改革实施后,样本医院全年病组运行的拨付差额情况,为医院在DRG付费的管理上提供有效的数据依据与决策支持。方法采用描述性统计与t检验,对主要病组的拨付差额与费用结构情况进行对比与分析。结果样本医院病组覆盖相对较全,病例数前20病组中,RE13病组医保拨付负差额最多,其中西药支出占67.37%,GD19病组在不同科室费用存在显著统计学差异。结论在DRG医保支付方式改革的浪潮下,医院须合理控制医疗费用,做好住院全过程管理,以降低病组拨付负差额。Objective To provide effective data and decision support for the management of diagnosis-related group(DRG)payment by analyzing the annual appropriations balance of disease groups in sample hospitals after the implementation of DRG payment reform.Methods Descriptive statistics and t test were used to compare and analyze the appropriations balance and expense structure of major disease groups.Results The sample hospitals had relatively complete coverage of disease groups.Among the top 20 disease groups in terms of the number of cases,the RE13 disease group had the largest negative appropriations balance in medical insurance,with western medicine expenses accounting for 67.37%.There were significant differences in the expense among different departments in the GD19 disease group.Conclusion Under the reform of DRG medical insurance payment methods,hospitals should reasonably control the medical expenses and improve the management of the entire hospitalization process management to reduce the negative balance of appropriation.

关 键 词：DRG付费 拨付差额 临床路径 

分 类 号：R197.322[医药卫生—卫生事业管理] F224.5[医药卫生—公共卫生与预防医学]