DRG付费下医院高倍率病例现状及费用结构分析——以武汉市某三甲医院为例  

The Current Situation and Cost Structure Analysis of Extremely High-Cost Cases in Hospitals Under the DRG Payment Method——Taking a Tertiary Hospital in Wuhan City as an Example

作　　者：丁敬美 蔡洁 韩磊 孙明 

机构地区：[1]中部战区总医院,武汉430070

出　　处：《中国医疗保险》2024年第8期79-86,共8页China Health Insurance

摘　　要：目的:通过分析武汉市某三甲医院DRG支付实施3年中高倍率病例的特征,探索高倍率病例的管理方法。方法:以武汉市某三甲医院2021年1月—2023年12月DRG入组病例中的高倍率病例为研究对象,采用描述性统计方法分析高倍率病例的基本特征和费用结构。结果:样本医院3年间的高倍率病例合计1585例(2.40%),年龄为64.00(51.00,74.00)岁,住院天数为15.06(10.00,24.66)天,病组权重为0.59(0.30,0.93)。所有患者的住院费用中位数为27116.08元,单项费用占比超过10%的三个单项费用分别是药费(22.85%)、检验费(17.94%)和治疗费(10.32%)。病例数前三位MDC为MDCB、MDCE和MDCC,前三位ADRG为BR2、ES2和CX1,前三位DRG病组为BR25、ES25和ES23。结论:样本医院高倍率病例发生率相对稳定,且以非疑难重症病组为主,尽管患者例均住院费用变化较小,但6个关键单项费用持续变化。建议从实施病种分类管理、规范临床路径、开展DRG数据分析和加速信息化建设等方面对高倍率病例进行管理。Objective:The paper explores the management methods for extremely high-cost cases by analyzing the characteristics of such cases during the 3-year implementation of DRG payment in a tertiary hospital in Wuhan City.Methods:This study focused on the extremely high-cost cases among the DRG cases from January 2021 to December 2023 in a tertiary hospital in Wuhan City.A descriptive analysis was conducted to investigate the basic characteristics and cost structure of these cases.Results:A total of 1585 cases(2.40%)with extremely high costs were identified in the sample hospital during the 3-year period.The age of these patients was 64.00 years(51.00,74.00),and the length of hospital stay was 15.06 days(10.00,24.66).The DRG weight was 0.59(0.30,0.93).The median total hospitalization cost for all patients was 27116.08 yuan.The three individual cost categories that accounted for more than 10%of the total cost were medication costs(22.85%),laboratory test costs(17.94%),and treatment costs(10.32%).The top three MDC with the most cases were MDCB,MDCE,and MDCC.The top three ADRG were BR2,ES2,and CX1.The top three DRG were BR25,ES25,and ES23.Conclusion:The incidence of extremely high-cost cases in the sample hospital is relatively stable,and they are mainly non-difficult and severe disease groups.Although the average hospitalization cost per patient has changed slightly,the key six individual costs have continued to change.Measures such as implementing disease classification management,standardizing clinical pathways,conducting DRG data analysis,and accelerating information construction can be taken to manage the extremely high costs cases.

关 键 词：DRG 高倍率病例 费用结构 病种分布 

分 类 号：F840.684[经济管理—保险]