按病种分值付费下医院医保精益管理对胃癌患者住院费用影响研究  

Research on the effect of lean management of hospital medical insurance on the costs of patients with gastric cancer under Diagnosis-Intervention Packet

作　　者：林骏爽 张兆晖[1] 陈芳玉 李琴 赵玮琳 王怡鑫[1] LIN Junshuang;ZHANG Zhaohui;CHEN Fangyu;LI Qin;ZHAO Weilin;WANG Yixin(Medical Insurance Department,Sichuan Cancer Hospital,Chengdu Sichuan 610041,China;Fund Supervision Department,Sichuan Medical Security Affairs Center,Chengdu Sichuan 610041,China)

机构地区：[1]四川省肿瘤医院医保处,四川成都610041 [2]四川省医疗保障事务中心基金监管部,四川成都610041

出　　处：《卫生软科学》2024年第6期55-59,共5页Soft Science of Health

基　　金：四川省科技厅重点研发项目(2019YFS0031)。

摘　　要：[目的]通过胃癌相关病例医保数据,研究医保按病种分值付费(DIP)下精益管理模式对诊疗费用的影响,为医疗机构合理控制诊疗费用以应对医保支付方式改革提供参考。[方法]在大型三甲肿瘤专科医院实施一种创新化的医院医保精益管理模式,按DIP分组规则将胃癌病例分为化疗组GU13、根治性手术组GA13和操作治疗组GR29,以精益模式实施前后为节点运用回顾性数据分析法验证其实施效果。[结果]纳入研究病例4935例,GU13组次均住院总费用、药品费呈下降趋势(P<0.001);GR29组药品费、耗材费呈下降趋势(P<0.001);GA13组次均住院天数、手术治疗费、药品费呈下降趋势(P<0.001)。[结论]以专家为核心的精益管理模式,有效保障了医疗质量、助力了医疗费用管控、加强了成本控制。Objective Based on the data of medical insurance of patients with gastric cancer,this paper studies the impact of lean management model on the diagnosis and treatment cost under Diagnosis-Intervention Packet,to provide the reference for medical institutions to reasonably control the diagnosis and treatment cost and cope with the reform of medical insurance payment.Methods An innovative lean management model of hospital medical insurance was implemented in a large tertiary cancer hospital.Patients with gastric cancer were divided into chemotherapy group GU13,radical surgery group GA13 and operation treatment group GR29 according to Diagnosis-Intervention Packet.The implementation effect was verified by retrospective data analysis before and after the implementation of the lean model.Results 4935 cases were included in the analysis.The total hospitalization cost per admission and drug cost in GU13 group decreased significantly(P<0.001).The cost of drugs and consumables in GR29 group showed a significant decreasing trend(P<0.001).The average hospitalization days per admission,surgical treatment cost and drug cost in GA13 group decreased significantly(P<0.001).Conclusions The lean management model with experts as the core has effectively guaranteed the quality of health care,helped the control of medical expenses,and strengthened cost control.

关 键 词：分值付费 精益管理模式 胃癌 医保控费 

分 类 号：R197.1[医药卫生—卫生事业管理] F842.6[医药卫生—公共卫生与预防医学]