DRG支付下住院费用变化及住院天数影响因素研究——以缺血性脑血管病为例  

Study on the Changes of Hospitalization Expenses and the Influencing Factors of the Length of Stay under DRG Payment Sampled with Ischemic Cerebrovascular Disease

作　　者：伍利香 蔡佳洁 周晓媛 Wu Lixiang(West China School of Public Health,West China Fourth Hospital of Sichuan University,Chengdu,P.R.China)

机构地区：[1]四川大学华西公共卫生学院/华西第四医院,四川成都610041

出　　处：《中国卫生事业管理》2024年第12期1370-1374,共5页Chinese Health Service Management

基　　金：科技部国家重点研发计划“健康管理综合服务应用示范”(2020YFC2006500);成都市DRG支付方式改革研究采购项目“成都市DRG支付方式改革研究”(SOBX-2023-1105)。

摘　　要：目的:分析按疾病诊断相关分组支付下缺血性脑血管病患者住院费用变化趋势及住院天数的影响因素,为完善医保支付和促进医院发展提出建议。方法:以省本级医保定点医院为例,收集113家不同等级医院7575例2020~2021年缺血性脑血管病住院患者数据,采用χ^(2)检验、Mann-Whitney U检验和多水平模型,综合分析政策前后不同级别医院间患者住院费用、住院天数变化情况及影响因素。结果:DRG实施后,缺血性脑血管病患者住院天数、检查费和治疗费均显著下降(P<0.05);单日次均费用、药品费和耗材费均上升(P<0.05),但各指标变化情况在不同级别医院间存在差异。结论:DRG实施后,住院天数缩短,年龄、DRG组别和病例类型是影响住院天数的影响因素,医保部门应考虑不同级别医院的特点,加强动态监管;同时各级医院应重视DRG评价结果,正视DRG支付下存在的问题和不足,加强内部成本和运营管理,保证医疗服务质量前提下提升医疗服务效率。Objective To analyze the trend of hospitalization expenses and the influencing factors of the length of stay in pa-tients with ischemic cerebrovascular disease under the payment of related groups of disease diagnosis,and put forward suggestions for improving medical insurance payment and promoting the development of hospitals.Methods Taking 113 provincial-level medi-cal insurance designated hospitals as an example,data on 7575 inpatients with ischemic cerebrovascular disease from 2020 to 2021 were collected.Chi-square test,Mann-Whitney U test and multilevel model were used to analyze the change of hospitalization costs,length of stay and its influencing factors among hospitals at dfferent levels before and after the implementation of the policy.Results After the implementation of DRG payment,it was significantly decreased in the hospitalization days,examination fees and treatment expenses of patients with ischemic cerebrovascular disease.Meanwhile,the daily cost,drug cost and material consump-tion cost increased(P<0.05),while there were differences in the changes of each indicator among hospitals at different levels.Conclusion The hospitalization days were shortened after the implementation of DRG payment.Age,DRG groups and case types are the main factors affecting the hospitalization days.Medical insurance department should consider the characteristics of hospitals at different levels and strengthen the dynamic supervision.At the same time,hospitals at all levels should pay attention to the re-sults of DRG evaluation,face up to the problems and deficiencies under DRG payment,strengthen internal cost and operation management,and improve the efficiency under the premise of ensuring the quality of medical services.

关 键 词：DRG 缺血性脑血管病 住院天数 住院费用 医院级别 

分 类 号：R197.1[医药卫生—卫生事业管理]