基于DRG的临床科室住院费用管理策略研究  

Strategy Analysis on the Hospitalization Cost Management of Clinical Departments Based on DRG

作　　者：陈曦[1] 王兰香[1] 邱茗[1] 彭强[1] Chen Xi;Wang Lanxiang;Qiu Ming(Shenzhen Luohu People’s Hospital,Shenzhen,Guangdong,518001,China;不详)

机构地区：[1]深圳市罗湖区人民医院,广东深圳518001

出　　处：《中国卫生经济》2024年第4期81-85,共5页Chinese Health Economics

摘　　要：目的:基于DRG医保付费数据评价2022年深圳市罗湖区人民医院各临床科室的住院费用管理情况,指导临床科室的差异性控费策略,探讨精细化病种管理策略,为改进临床科室住院费用管理方法提供依据。方法:使用波士顿矩阵分析医院各临床科室的住院费用管理情况,并使用熵权TOPSIS法和秩和比法对临床科室DRG病种管理现状进行分析。结果:42个临床科室中高医保结余率、高CMI的科室9个,低医保结余率、高CMI的科室8个,医保结余率和CMI双低的科室10个,高医保结余率、低CMI的科室15个。根据熵权TOPSIS法和秩和比法,将骨伤科的DRG病种分为优势病种、潜力病种、劣势病种3类(经单因素方差分析,F=55.762,P<0.001)。结论:应对住院费用管理现状不同的临床科室实行差异性费用管理策略,改善结余分配机制,精细化病种管理,实现以价值医疗为导向的高质量可持续发展。Objective:Based on DRG medical insurance payment data,it evaluated the hospitalization cost management of clini⁃cal departments in Shenzhen Luohu People’s Hospital in 2022,guided the differential cost control strategy of clinical departments,and discussed the refined disease management strategy,so as to provide a basis for optimizing cost management methods in clinical hospitalization.Methods:The BCG Matrix was used to analyze the hospitalization expenses management of clinical departments in the hospital.The entropy weight TOPSIS method and rank sum ratio method were used to analyze the current situation of DRG disease type management in clinical departments.Results:Among the 42 clinical departments,9 departments had high medical insurance balance rate and high CMI,8 departments had low medical insurance balance rate and high CMI,10 departments had double low balance rate and CMI,and 15 departments had high medical insurance balance rate and low CMI.According to the entropy weight TOPSIS method and the rank sum ratio method,the DRG disease type of orthopedics and traumatology were divided into three catego⁃ries:dominant diseases,potential diseases and inferior diseases(based on one-way analysis of variance,F=55.762,P<0.001).Conclusion:Different cost management strategies should be implemented in clinical departments with different current status of hos⁃pitalization expenses management,so as to improve the balance distribution mechanism,refine disease type management,and achieve high-quality and sustainable development of value-oriented medical.

关 键 词：波士顿矩阵 住院费用管理 病种管理 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] F2[经济管理—国民经济]