基于间断时间序列分析的三明市公立医院DRG改革效果的综合评估  

Comprehensive evaluation of the effect of DRG reform in Sanming public hospitals based on interrupted time series analysis

作　　者：李及第 李敏[1] 宫春博[1] LI Jidi;LI Min;GONG Chunbo(Shandong University of Traditional Chinese Medicine,Jinan Shandong 250000,China)

机构地区：[1]山东中医药大学,山东济南250000

出　　处：《卫生软科学》2024年第4期1-5,共5页Soft Science of Health

基　　金：2021年山东省研究生教育质量提升计划项目(SDYKC21053)。

摘　　要：[目的]分析三明市C-DRG和CN-DRG医保支付方式改革对二级、三级公立医院医疗收入、服务效率和患者负担的影响。[方法]采用间断时间序列、灰色关联度和结构变动度分析方法对2015-2019年22家公立医院的医药收入等指标进行回顾性分析。[结果]三明市实施DRG医保支付方式改革后二级医院的医疗收入降低5.2%,对三级医院的医疗收入没有显著影响;二级、三级医院的平均住院天数和病床使用率无显著改变;三级医院的门急诊次均费用增长2%,出院例均费用未受显著影响;二级医院的出院例均费用降低10.8%后增长8.4%。[结论]在三明市的DRG改革下,公立医院情况稳中向好;DRG可以完善临床路径,促进医疗机构的成本管控,未来的医改进程中,应考虑不同等级医院特点,加强改革的监督管理。Objective To analyze the impact of C-DRG and CN-DRG payment reform in Sanming city on medical income,service efficiency and patient burden in secondary and tertiary public hospitals.Methods By using the methods of interrupted time series,grey correlation degree and structural variation,the pharmaceutical income and other indicators of 22 public hospitals from 2015 to 2019 were retrospectively analyzed.Results After the implementation of DRG payment reform in Sanming city,the medical income of secondary hospitals decreased by 5.2%,and it had no significant impact on the medical income of tertiary hospitals.The average length of stay and the utilization rate of beds in secondary and tertiary hospitals had no significant change.The average cost of outpatient and emergency per visit in tertiary hospitals increased by 2%,and the average cost of discharged cases was not significantly affected.The average cost of discharges at secondary hospitals increased by 8.4%after a decrease of 10.8%.Conclusions Under the DRG reform in Sanming city,the situation of public hospitals is stable and improving.DRG can improve the clinical pathway and promote the cost control of medical institutions.In the future process of medical reform,the characteristics of different levels of hospitals should be further considered,and the supervision and management of the reform should be strengthened.

关 键 词：DRG 医保支付方式改革 间断时间序列分析 

分 类 号：R197[医药卫生—卫生事业管理]