按病种分值付费管理助力医院发展提质增效  

Enhancing hospital quality and efficiency through big data diagnosis-intervention packet

作　　者：卢从斌 刘敬[2] LU Congbin;LIU Jing(Guangzhou Chest Hospital,Guangzhou 510095,China;Guangzhou First People’s Hospital,Guangzhou 510180,China)

机构地区：[1]广州市胸科医院,广东广州510095 [2]广州市第一人民医院,广东广州510180

出　　处：《现代医院》2023年第11期1647-1648,1651,共3页Modern Hospitals

基　　金：国家卫生健康委卫生发展研究中心委托项目(2022RFT007);广东省卫生经济学会面上课题(2022-WJMZ-12,粤卫经[2022]23号)。

摘　　要：目的 在按病种分值付费(big data diagnosis-intervention packet, DIP)支付改革推动下,结合医院党建引领下的医保管理工作实际,从制度保障、培训引导、沟通反馈和科室互联等方面推动公立医院医保支付体系的建设,并提出相应的具体措施,为新医保支付下公立医院体制建设发展提供新的思路,为医院发展提质增效,实现医保患三方共赢。方法 收集广州市某三甲医院2019年1月1日—2021年12月31日广州医保按病种分值付费结算的住院患者95 544例,采用单因素方法对病种分值管理培训前后的费用等进行分析。结果 培训后患者的中位住院时间、住院费用、记账费用、综合病种占比、偏差病例占比较培训前降低,结余较培训前升高。结论 实施医保奖惩办法后,通过培训可有效降低患者的住院费,增加医保结余。Objective This paper aims to enhance public hospital insurance payment systems under the promotion of DIP payment reform,combined with medical insurance management guided by Party building philosophy.It promotes the construction of a medical insurance payment system of public hospitals from the aspects of system guarantee,training guidance,communication feedback and interdepartmental connectivity.The paper puts forward concrete measures to provide new ideas for public hospital system construction under the new medical insurance payment scheme,aiming to improve the efficiency and performance of hospitals and achieve a win-win situation for public hospitals,medical insurance providers,and patients.Methods The data of 95544 inpatients who underwent DIP-settled payment from January 1,2019 to December 31,2021 in a tertiary hospital in Guangzhou were analyzed.A univariate analysis was conducted to compare the costs before and after the introduction of the Big Data Diagnosis-Intervention Packet.Results After the training,there was a remarkable decrease in the median hospital stay,hospitalization costs,accounting expenses,the proportion of comprehensive diseases,and the proportion of deviation cases,and an increase in the balance financially compared with those before the training.Conclusion Following the implementation of reward and penalty measures of medical insurance,the training can effectively reduce patient hospitalization costs and increase the medical insurance surplus.

关 键 词：DIP 医保支付改革 党建 

分 类 号：R197.32[医药卫生—卫生事业管理]