安徽省某三甲医院DRG付费运行结果分析研究  

Analysis and Research on DRG Payment Operation Results of a Certain Grade A Tertiary Hospital in Anhui Province

作　　者：张冰 王雷[1] ZHANG Bing;WANG Lei(Department of Health Insurance,The First Affiliated Hospital of Ustc,Division of Life Sciences and Medicine,University of Science and Technology,Hefei,Anhui,230001)

机构地区：[1]中国科学技术大学附属第一医院、安徽省立医院医保处,安徽合肥230001

出　　处：《江苏卫生事业管理》2024年第2期249-252,256,共5页Jiangsu Health System Management

摘　　要：目的:分析安徽省某三甲医院2022年DRG付费运行数据,探讨改革对医院运营管理带来的挑战并提出相应对策,为DRG预付费改革提供数据参考。方法:采用描述性统计方法,对样本医院DRG付费整体运行结果和病组盈亏结构进行分析。结果:样本医院2022年DRG付费涵盖病组较全面,整体呈盈余状态,54.08%病例的RW值偏低,部分病组超支付标准较多,相关专科控费压力较大。结论:医院应转变传统观念,优化病种结构和临床路径,构建MDT多部门联动机制,加强信息化监管,提高病案质量,逐步实现DRG付费的精细化管理。Objective:To analyze the DRG prepaid operation data of a certain grade A tertiary hospital in Anhui Province in 2022,explore the challenges posed by the reform to hospital operation and management,and propose corresponding countermeasures to provide data reference for the DRG prepaid reform.Methods:Descriptive statistical methods were used to analyze the overall operating results of DRG payment and the profit and loss structure of patient groups in sample hospitals.Results:In 2022,the DRG payment of the sample hospitals covered a relatively comprehensive range of patients,with an overall surplus status.54.08%of the cases had a low RW value,and some patients exceeded the payment standards,resulting in significant pressure on relevant specialized departments to control fees.Conclusion:Hospitals should change traditional concepts,optimize the structure of disease types and clinical pathways,establish a multi department linkage mechanism for MDT,strengthen information based supervision,improve the quality of medical records,and gradually achieve refined management of DRG payments.

关 键 词：三甲医院 医保支付方式改革 DRG付费 

分 类 号：R197.1[医药卫生—卫生事业管理]