DRG付费模式下患者医疗负担的变化趋势研究  

Study on the Changing Trend of Patients'Medical Burden Under DRG Payment Mode

作　　者：周道亮 ZHOU Daoliang(Medical Records and Statistics Room,Health Community Group of Yuhuan People's Hospital,Yuhuan Zhejiang 317600,China)

机构地区：[1]玉环市人民医院健共体集团病案统计科,浙江玉环317600

出　　处：《中国卫生标准管理》2023年第22期37-40,共4页China Health Standard Management

基　　金：浙江省康恩贝医院管理软科学研究项目(2023ZHAKEB336)。

摘　　要：目的评估在医保支付方式改革实施后,浙江省按疾病诊断相关分组(diagnosis related groups,DRG)付费模式对全省二、三级综合医院住院患者平均医疗负担变化的影响,为继续扩大推动DRG付费政策提供有效的数据支持。方法以浙江省医院质量管理与绩效评价平台提供2019—2022年浙江省二、三级医院DRG质量绩效分析报告为依据,使用Microsoft Excel建立数据库,并采用描述性统计方法,对DRG付费政策实施前后住院患者医疗负担的变化进行对比与分析。结果在DRG付费模式下,各等级医疗机构住院患者平均住院天数下降明显;除温州市以外的10个地区及省级医院,经病例组合指数(case mix index,CMI)校正后的住院患者平均费用下降明显。结论DRG付费模式的应用,促进医疗机构主动从粗放型管理向精细化转变,主动顺应DRG付费改革机制,通过调整与规范自身诊疗行为,强化临床路径等管理工具的应用,达到降低住院患者医疗负担目的,从而提高医保基金的使用效率,降低医保基金存在穿底的风险。Objective To evaluate the impact of the diagnosis related groups(DRG)payment mode on the average medical burden of inpatients in secondary and tertiary general hospitals in Zhejiang Province after the implementation of the reform of medical insurance payment mode,and to provide effective data support for further expanding and promoting the DRG payment policy.Methods The quality performance analysis report of secondary and tertiary hospitals(DRG)in Zhejiang Province from 2019 to 2022 was provided by Zhejiang Hospital quality management and performance evaluation platform.Microsoft Excel was used to establish a database and descriptive statistics method was adopted.The changes of medical burden of inpatients before and after the implementation of DRG payment policy were compared and analyzed.Results Under DRG payment mode,the average length of stay of inpatients in all levels of medical institutions decreased significantly,except Wenzhou,10 regional and provincial hospitals,the average cost of inpatients after case mix index(CMI)correction decreased significantly.Conclusion The application of DRG payment mode forces medical institutions to actively change from extensive management to fine management,actively adapt to the DRG payment reform mechanism,and reduce the medical burden of inpatients by adjusting and standardizing their own diagnosis and treatment clinics and strengthening the application of management tools such as clinical pathways,thereby improving the use efficiency of medical insurance funds and reducing the risk of medical insurance funds running out.

关 键 词：DRG付费 平均费用 CMI 校正 平均住院天数 绩效 

分 类 号：R197[医药卫生—卫生事业管理]