DRG医保支付背景下的高血压住院费用影响因素及结构变动分析  

Analysis of Influencing Factors and Structural Changes of Hospitalization Cost of Hypertension in the Context of DRG Medical Insurance Payment

作　　者：葛龙[1] 王月[1] 李丞[1] 张南[1] Ge Long;Wang Yue;Li Cheng;Zhang Nan(State Key Laboratory of Pathogenesis,Prevention and Treatment of High Incidence Diseases in Central Asia,The First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang Uygur Autonomous Region,830001,China)

机构地区：[1]新疆医科大学省部共建中亚高发病成因与防治国家重点实验室,第一附属医院,新疆维吾尔自治区乌鲁木齐市830001

出　　处：《中国病案》2024年第4期41-45,共5页Chinese Medical Record

基　　金：省部共建中亚高发病成因与防治国家重点实验室开放课题项目(SKL-HIDCA-2021-54);新疆维吾尔自治区“青年科技人才-乡村振兴”项目(WJWY-XCZX202237);新疆维吾尔自治区医院管理研究所项目(ZZQYYGLYJS-202108B)。

摘　　要：目的分析DRG试点下某三甲医院高血压住院病例的费用影响因素及费用结构变动情况,为DRG支付下医院高血压住院科学管理提供一定参考依据。方法采用非参数方法分析2020年1月1日-2022年12月31日期间,住院病案首页主要诊断包含高血压的13006份出院病例住院费用间的差异,运用多元逐步回归分析住院费用的影响因素,并通过结构变动度分析住院费用结构变动情况。结果研究病例住院病案首页主要诊断以高血压病3级(极高危)为主,病例主要分布在心血管相关科室和综合类科室,病例的手术/操作占比较低。化验费和检查费是住院费用最主要的影响因素,其余依次为治疗费、药品费用、床位费、入院就诊科室、手术/操作、病理费、民族、医保类型和主要诊断;2020年-2022年,次均住院费用降幅为12.56%;检查费和化验费结构占比呈正向变动,变动度分别为2.54%和1.21%,病理费和药费结构占比呈负向变动,变动度分别为-2.76%和-1.28%。病理费结构变动贡献率为31.76%。结论DRG医保支付方式改革可有效降低高血压患者住院次均医疗费用,但医疗费用中各项费用的结构占比不够合理,且随医保支付方式改革的推进住院费用中各项费用结构变化不显著。建议进一步完善医疗服务项目种类和价格、强化临床路径管理、院前门诊统筹政策的落地持续控制医疗费用水平的同时优化费用结构。Objectives This paper analyzed the factors influencing the cost of hypertension inpatients and the changes of the cost structure in a Three A and Tertiary Hospital under DRG pilot,and provided some reference for the scientific management of hypertension inpatients in hospitals under DRG payment.Methods Non-parametric methods were used to analyze the differences in hospitalization costs among 13006 discharged cases with hypertension as the main diagnosis on the first page of inpatient medical records during the period from January 1st,2020 to December 31st,2022.Multiple step-based regression was used to analyze the influencing factors of hospitalization costs,and the structural changes of hospitalization costs were analyzed through the degree of structural changes.Results The main diagnosis of the inpatient medical records of the study cases was grade 3 hypertension(extremely high risk),and the cases were mainly distributed in cardiovascular related departments and general departments,with a relatively low proportion of surgeries/operations.Laboratory fee and examination fee were the main influencing factors of hospitalization fee,followed by treatment fee,drug fee,bed fee,admission department,operation/operation,pathology fee,nationality,type of medical insurance and main diagnosis.From 2020 to 2022,the average hospitalization cost will decrease by 12.56%;The proportion of examination fee and laboratory fee structure changes positively with the variation degree of 2.54%and 1.21%respectively,while the proportion of pathology fee and drug fee structure changes negatively with the variation degree of-2.76%and-1.28%respectively.The contribution rate of pathological fee structure change was 31.76%.Conclusions The reform of DRG medical insurance payment method could effectively reduce the average hospitalization cost of hypertension patients,but the structure of various expenses in the medical expenses was not reasonable,and the change of various expenses structure in hospitalization expenses was not significant with t

关 键 词：高血压 DRG 影响因素 结构变动 

分 类 号：R544.1[医药卫生—心血管疾病] R197.3[医药卫生—内科学]