DRG支付背景下的手术患者住院费用分析与医用耗材成本管控探讨  

Analysis of hospitalization cost of surgical patients and management of medical consumables cost in DRG payment

作　　者：刘雯 龙颖 刘磊 Liu Wen;Long Ying;Liu Lei(Chongqing Technology and Business University,Chongqing 400067,China;The Fifth People's Hospital of Chongqing,Chongqing 400062,China;The People's Hospital of Nan'an,Chongqing 400060,China)

机构地区：[1]重庆工商大学,重庆400067 [2]重庆市第五人民医院,重庆400062 [3]重庆市南岸区人民医院,重庆400060

出　　处：《保健医学研究与实践》2023年第11期132-135,共4页Health Medicine Research and Practice

基　　金：重庆市自然科学基金项目(cstc2021jcyj-bshX0186)。

摘　　要：目的探讨普通外科重点关注手术DRG组的费用结构及可能的影响因素,为医院如何控制医疗成本提供合理建议。方法回顾性选择重庆市某三甲医院普通外科2022年1—10月入组DRG的手术病例作为研究对象,统计分析手术DRG组的有关信息。比较分析各手术DRG组的住院费用信息及盈余情况;比较分析各手术DRG组中的费用结构;以HC33组为例,比较分析不同医疗组(A组、B组)对患者住院信息的影响。结果8个重点关注手术DRG组在实行DRG支付模式后均实现了盈余,但各组间盈利差异较大,盈余占DRG支付标准比例最高的为GF19组的19.21%,而最少的KD19组仅占1.39%。对重点关注手术DRG组进行费用结构统计发现:手术患者住院费中医疗费占28.8%,耗材费占27.2%,药品费占21.5%,医技费占17.3%。其中GF19组中医疗费占比最高,而耗材费占比最低。A组患者住院费、手术耗材费高于B组,差异均有统计学意义(P<0.05)。2组患者住院天数、术后并发症发生率、满意度比较,差异无统计学意义(P>0.05)。结论在保证患者安全和医疗质量的前提下,通过对手术医用耗材的管控,能够改善临床科室成本结构,降低医疗成本。Objective This paper aims to investigate the cost structure and possible influencing factors of the DRG group in key surgeries of the general surgery department and to provide suggestions on how to control medical costs in hospitals.Methods The surgical cases of DRG enrolled in the general surgery department of a grade A tertiary hospital in Chongqing from January to October 2022 were retrospectively selected as the study participants.The relevant information of the surgical DRG group was statistically analyzed.The hospitalization cost information and surplus of each surgical DRG group were compared and analyzed;the cost structure in each surgical DRG group was compared and analyzed.The effect of different medical groups(groups A and B)on the hospitalization information of patients was compared and analyzed,with the HC33 group as an example.Results All of the 8 DRG groups with key surgeries achieved surplus according to DRG payment mode,but the profit was markedly different between the groups.The highest proportion of surplus in the DRG payment standard was 19.21% in the GF19 group,while the lowest KD19 group accounted for only 1.39%.According to the cost structure statistics of DRG groups,medical expenses,consumables,drugs,and medical technology accounted for 28.8%,27.2%,21.5%,and 17.3%,respectively.Among them,the GF19 group had the highest proportion of medical expenses,while consumable expenses had the lowest proportion.The hospitalization cost and surgical consumable cost of patients in group A were significantly higher than those in group B(P<0.05).The differences in the length of hospital stays,incidence of postoperative complications,and degree of satisfaction between the two groups were not statistically significant(P>0.05).Conclusion Under the premise of ensuring patient safety and medical quality,the cost structure of clinical departments can be strengthened and medical costs can be reduced through the management and control of surgical medical consumables.

关 键 词：DRG 住院费 医用耗材 成本管控 

分 类 号：R197.1[医药卫生—卫生事业管理]