武汉市DRG入组病例的费用倍率特征分析  

Analysis of the Characteristics of Medical Cost Rate of DRG Enrolled Cases in Wuhan City

作　　者：丁敬美 韩磊 杜进兵 DING Jingmei;HAN Lei;DU Jinbing(Central Theater Command General Hospital of the People's Liberation Army of China,Wuhan Hubei 430000,China;不详)

机构地区：[1]中国人民解放军中部战区总医院,湖北武汉430000

出　　处：《卫生经济研究》2023年第12期28-32,共5页

基　　金：中部战区总医院2021年度育英计划孵化项目“军队伤病员住院医疗费用合理控制研究”(ZZYFH202103)。

摘　　要：目的:分析DRG入组病例的倍率分布特征,推测非等倍率病例发生的原因并提出针对性改进措施。方法:以武汉市某三甲医院2022年1—9月DRG入组病例为研究对象,按照费用消耗指数分组,描述不同倍率病例的基本特征,采取帕累托图法分析不同倍率病例的主要诊断分类(MDC)和DRG病组构成。结果:16418例病例中,低倍率、高倍率、极低倍率和极高倍率病例分别为8319例(50.67%)、5410例(32.95%)、1698例(10.34%)和830例(5.06%),不同倍率病例在MDC分布、前10位DRG病组构成方面的差异有统计学意义。结论:样本医院DRG入组病例中,低倍率病例占优势,MDC分布体现了以收治老年患者和优势学科患者为主的特点,优势DRG病组的权重整体不高,存在权重与费用倒置的现象;医院应结合自身实际,采取针对性措施完善DRG支付体系,从而实现高质量发展。Objective To analyze the distribution characteristics of medical cost rate of DRG enrolled cases,speculate on the causes of non-equal rate cases,and to propose targeted improvement measures.Methods Taking DRG enrolled cases from a tertiary hospital in Wuhan from January to September 2022 as the research object,grouped by cost consumption index,the basic characteristics of cases with different rates were described.The Pareto diagram method was used to analyze the main diagnostic classification(MDC)and DRG disease group composition of cases with different rates.Results Among the 16418 cases,the low-rate,the high-rate,the very low-rate and the very high-rate cases were 8319(50.67%),5410(32.95%),1698(10.34%)and 830 cases(5.06%),respectively.There were statistically significant differences in MDC distribution and composition of the top 10 DRG disease groups among cases with different rates.Conclusion Among the DRG enrolled cases in the sample hospital,low-rates cases are dominant,and the MDC distribution reflects the characteristics of mainly treating elderly patients and patients in dominant disciplines.The weight of the top DRG disease groups is not high,and there is a phenomenon of the inversion of weight and cost.In order to achieve high-quality development,hospitals should take targeted measures to improve the DRG payment system based on their own reality.

关 键 词：医疗费用 倍率 疾病诊断相关分组 高倍率病例 低倍率病例 

分 类 号：F840.684[经济管理—保险]