CHS-DRG付费制度下GB1分组住院费用影响因素分析与管理策略探讨  

Influencing factors and management strategies for GB1 group hospitalization expenses under the CHS-DRG payment system

作　　者：胡云鹤 周玉焯 付瑞瑛 于凡 李爱东 Yunhe Hu;Yuzhuo Zhou;Ruiying Fu;Fan Yu;Aidong Li(Medical Insurance Administration Office,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Prevention and Control Department,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院医疗保险管理办公室,北京100021 [2]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院预防控制部,北京100021

出　　处：《中华临床医师杂志(电子版)》2024年第6期568-574,共7页Chinese Journal of Clinicians(Electronic Edition)

基　　金：首都卫生管理与政策研究基地开放性课题资助(2024JD09)

摘　　要：目的分析国家医疗保障疾病诊断相关分组(CHS-DRG)付费制度下GB1(食管、胃、十二指肠大手术)分组住院费用影响因素,在此基础上提出有效的费用管理策略。方法本研究通过采用回顾性研究方法,收集了北京地区某三甲肿瘤专科医院在2018年1月~2023年12月纳入GB1(食管、胃、十二指肠大手术)分组的9732例病案首页及住院费用数据。通过单因素对比和多因素线性回归分析,评估食管相关手术及非食管相关手术对住院费用的影响,以及患者性别、年龄、医疗保险、住院天数等其他潜在影响因素。结果GB1分组中男性患者比女性患者占比高,患者年龄区间为15~94岁,平均年龄为60.6岁,住院天数8~15 d占比60.9%。纳入分析的因素中性别、年龄、医疗保险支付方式、是否伴有严重并发症或合并症以及住院天数均对GB1(食管、胃、十二指肠大手术)住院费用影响显著(P<0.05)。结论在CHS-DRG付费制度下,通过优化诊疗流程、缩短住院天数、预防并发症以及合理选择治疗方式可以有效控制GB1分组患者的住院费用。建议加强对这些关键因素的监控和管理,实施客观公平的费用控制策略,以提高资源的使用效率,降低不必要的医疗开支,同时保证患者获得高质量的医疗服务,进一步提升CHS-DRG付费制度的科学性、公平性与适用性,提高医疗机构的服务效率和质量,实现医保、医患、医疗三方共赢。Objective To analyze the influencing factors of major esophagus,stomach,and duodenum surgery(GB1)group hospitalization expenses under the China Healthcare Security Diagnosis Related Groups(CHS-DRG)payment system,and to propose effective cost management strategies on this basis.Methods This study used data from retrospectively collected information on the first pages of medical records and expenses of hospitalizations of 9732 cases in a tertiary cancer specialty hospital in Beijing.All cases were included in the GB1(major esophageal,stomach,and duodenum surgery)group from January 2018 to December 2023.Through univariate and multivariate analyses,we evaluated the impact of esophageal-related surgeries and non-esophageal-related surgeries,as well as other potential influencing factors,on hospitalization costs,including patient gender,age,medical insurance,and length of hospitalization.Results In the GB1 group,the proportion of male patients was higher than that of female patients.The age of the patients ranged from15 to 94 years old,with an average age of 60.6 years old,and the proportion of patients with hospitalization days between 8 and 15 accounted for 60.9%.Gender,age,medical insurance,serious complications or comorbidities,and length of hospitalization had significant impacts on the hospitalization costs of GB1(esophageal,stomach,and duodenal major surgery)patients(P<0.05).Conclusion Under the CHS-DRG payment system,the hospitalization expenses of patients in the GB1 group can be effectively controlled by optimizing the diagnosis and treatment process,shortening the length of hospitalization,preventing complications,and rationally selecting treatment methods.It is recommended to strengthen the monitoring and management of these key factors and implement objective and fair cost control strategies to improve the efficiency of resource use and reduce unnecessary medical expenses,while ensuring that patients receive high-quality medical services.It is essential to further improve the soundness,fairness,and applica

关 键 词：国家医疗保障疾病诊断相关分组 食管大手术 胃大手术 十二指肠大手术 住院费用 影响因素 管理策略 

分 类 号：R197.3[医药卫生—卫生事业管理]