某三甲专科医院DRG超支病例住院费用结构研究  

Study on the Inpatient Cost Structure of DRG Overrun Cases in a Certain Grade A Tertiary Specialized Hospital

作　　者：付文鹏[1] 徐亮[2] 卢诚震[1] FU Wenpeng;XU Liang;LU Chengzhen(Medical Insurance Department,Tianjin Second People’s Hospital,Tianjin 300192,China;Department of Chronic Hepatology and Minimally Invasive Oncology Treatment,Tianjin 300192,China)

机构地区：[1]天津市第二人民医院医保科,天津300192 [2]天津市第二人民医院慢性肝病科暨肿瘤微创治疗科,天津300192

出　　处：《江苏卫生事业管理》2024年第4期545-549,共5页Jiangsu Health System Management

基　　金：天津市卫健委科技项目(TJWJ2022XK034)。

摘　　要：目的:通过分析天津市某三甲专科医院DRG超支病例的费用构成及其变化规律,旨在为医院费用结构优化、管理效率提升及成本控制提供依据。方法:研究对象为2023年该医院DRG超支金额排名前15的病组,采用结构变动度法分析费用影响因素,并通过灰色关联分析评估各费用分项与总费用的关联度。结果:从7840例病例中筛选出2822例DRG超支病例(占35.99%),主要超支集中在RG13、ES31、HR11、EX23、EX21组。费用主要包括药品费、影像检查费、化验费和治疗费,且这些费用分项在超支与正常病例间存在结构差异,对住院费用的影响各不相同。灰色关联分析揭示影像检查费、化验费在11个DRG组中与总费用关联最强,药品费在3个组中关联最强,床位费在1个组中关联最强。结论:通过调整影像检查费、化验费、药品费和治疗费,可以有效控制医院成本,减少患者住院费用,优化医保基金利用,实现医院、患者和医保基金的共赢。Objective:This study aims to analyze the composition and variation patterns of DRG overrun cases in a certain grade A tertiary specialty hospital in Tianjin City,to provide a basis for optimizing hospital cost structure,improving management efficiency,and controlling costs.Methods:The subjects of the study were the top 15 DRG groups with the highest average overrun amounts in 2023.The structural variation method was used to analyze the factors affecting costs,and grey relational analysis was employed to evaluate the correlation between each cost component and the total hospitalization costs.Results:Out of 7840 cases,2822 DRG overrun cases were selected(accounting for 35.99%),primarily concentrated in the RG13,ES31,HR11,EX23,and EX21 groups.The main costs included medication,imaging tests,laboratory tests,and treatment fees,with varying structural differences and impacts on hospitalization costs between overrun and normal cases.Grey relational analysis revealed that imaging and laboratory fees had the strongest correlation with total costs in 11 DRG groups,medication fees had the strongest correlation in 3 groups,and bed fees had the strongest correlation in 1 group.Conclusion:By adjusting the costs of imaging tests,laboratory tests,medications,and treatments,hospital costs can be effectively controlled,patient hospitalization expenses can be reduced,and the utilization of medical insurance funds can be optimized,achieving a win-win situation for hospitals,patients,and medical insurance funds.

关 键 词：DRG付费 超支病例 结构变动度 成本控制 

分 类 号：R197.1[医药卫生—卫生事业管理]