DIP付费下抑郁症患者住院费用的结构变动及灰色关联分析——以江苏省扬州市某综合性医院为例  

Structural variation and grey correlation analysis of hospitalization expenses of patients with depression under DIP payment-take a general hospital in Yangzhou City,Jiangsu Province as an example

作　　者：高霞[1] 朱瑞轩 蔡滨[1] 石元洪[1] 史力群[1] 杨扬[1] 董丽平[1] 童萍[1] 钱少敏[1] GAO Xia;ZHU Ruixuan;CAI Bin;SHI Yuanhong;SHI Liqun;YANG Yang;DONG Liping;TONG Ping;QIAN Shaomin(Department of Clinical Psychology,Northern Jiangsu People's Hospital,Yangzhou Jiangsu 225001,China;School of Public Health,Dalian Medical University,Dalian Liaoning 116044,China)

机构地区：[1]江苏省苏北人民医院临床心理科,江苏扬州225001 [2]大连医科大学公共卫生学院,辽宁大连116044

出　　处：《卫生软科学》2024年第9期69-73,共5页Soft Science of Health

基　　金：2023年度江苏省苏北人民医院管理课题-DIP付费方式下精神障碍患者住院费用的灰色关联分析及对临床路径的影响(YYGL202319)。

摘　　要：[目的]分析综合性医院心理科按病种分值付费(DIP)改革前后抑郁症患者住院费用的变化情况,为完善医保支付方式改革提供实证数据支持。[方法]将样本医院DIP实际执行时间收集抑郁症住院患者分为改革前和改革后两组,采用卡方检验对基本信息进行组间差异性分析;采用结构变动分析和灰色关联分析抑郁症患者次均住院总费用和分项费用变化情况。[结果]DIP改革前后,患者年龄、性别差异无统计学意义(P>0.05);改革后住院天数缩短(P<0.05),次均住院总费用下降(P<0.01);结构变动分析显示2021-2023年抑郁症患者次均住院费用结构变动度(DSV)为33.08%,变动较大;单项次均住院费用结构变动贡献率(CSV)排名前3的是治疗费、医技诊断项目费和药品费,是导致抑郁症患者住院费用变动的主要影响因素。灰色关联分析显示患者次均住院费用中治疗费与总费用的关联系数度为0.930,关联度最高。[结论]DIP改革对优化住院费用结构、缩短平均住院日、降低总费用、提高医务人员合理控费有促进意义,但仍有进一步提升的空间。Objective To analyze the changes of hospitalization expenses of patients with depression before and after the DIP reform in the psychology department of a general hospital,and to provide empirical data and support for improving the reform of medical insurance payment.Methods According to the implementation time of DIP in the sample hospital,the information of inpatients with depression was collected and they were divided into two groups before and after the reform.The chi-square test was used to analyze the differences of basic information between groups.Structural variation and grey correlation analysis were used to analyze the changes of total and sub-item costs of average hospitalization expenses per admission of patients with depression.Results Before and after the DIP reform,there was no statistically significant in differences of patients age and gender(P>0.05).The length of hospital stay was shortened(P<0.05),and average hospitalization expenses per admission decreased after the reform(P<0.01).Structural variation analysis showed that the degree of structure variation(DSV)of average hospitalization expenses per admission of patients with depression from 2021 to 2023 was 33.08%,with a large variation.The top three contribution rates of structural variation(CSV)of average single hospitalization expense per admission were treatment cost,medical diagnostics cost and drug cost,which were the main factors that caused the change of hospitalization expenses of patients with depression.Grey correlation analysis showed that the correlation coefficient between treatment cost and total cost was 0.930,which was the highest in average hospitalization expenses per admission.Conclusions DIP reform is helpful to optimize the structure of hospitalization expenses,shorten the average length of stay,reduce the total cost and control cost reasonably for health workers,but there is still room for further improvement.

关 键 词：按病种分值付费 抑郁症 付费方式 灰色关联分析 结构变动度 

分 类 号：R194[医药卫生—卫生事业管理]