DIP支付下输血病例的费用倍率及影响因素研究  

Study on the Cost Ratio and Influencing Factors of Blood Transfusion Cases Under the DIP Payment

作　　者：罗玲 陈斌 黄伟 黄燕萍 李昀梦 叶子轶 曾雪琴 

机构地区：[1]四川省南充市营山县中医医院,南充637700 [2]四川省南充市阆中慈念医院,南充637400 [3]四川省泸州市医疗保障事务中心,泸州646000 [4]四川省泸州市纳溪区医疗保障局,泸州646300 [5]西南医科大学,泸州646000

出　　处：《中国医疗保险》2025年第2期105-111,共7页China Health Insurance

基　　金：四川医院管理和发展研究中心“新质生产力驱动下中医医疗机构DIP改革的动态能力研究”(SCYG2024-35);西南医科大学社科联项目(2023SKYB003);四川中医药发展研究中心项目“高质量发展视域下泸州中医药文化产业助力乡村振兴路径研究”(DJKYB202323);南充市社科规划项目“健康人文研究”专项课题“DIP改革下低价值医疗的识别与治理研究”(NC24CB10);南充市社科规划项目“健康南充研究”专项课题“医保支付方式改革对民营医院高质量发展的影响与路径优化研究”(NC24JK13)。

摘　　要：目的:分析输血病例的费用倍率特征及影响因素,促进医保支付方式改革精细化发展。方法:以泸州市2023年14864例输血病例为研究对象,采用四象限气泡图、结构方程模型方法,对其费用倍率及影响因素进行分析。结果:输血病例整体费用倍率为1.36,DIP支付率为86.40%。四象限气泡图显示,输血病例前20个病种中大部分病种位于第一象限(输血病例占比高、费用倍率高)和第二象限(输血病例占比低、费用倍率高)。结构方程模型显示,输血病例费用倍率影响因素的总效应从高到低依次为住院天数(0.623)、CMI值(-0.448)、血液费(0.228)、离院方式(0.060)、治疗方式(-0.034)。结论:输血病例费用倍率较高,DIP支付下超支风险较高;血液费与其他因素共同影响输血病例的费用倍率。建议依据资源消耗将输血纳入次要手术操作,并作为病种成组依据;针对费用倍率比较稳定、输血病例达到一定比例的病种,构建以输血指征为主要校正依据的输血辅助目录,优化输血病例医保结算规则。Objective:The paper analyzes the characteristics and influencing factors of the cost ratio of blood transfusion cases,in order to promote the reform and refined management of medical insurance payment methods.Methods:A total of 14864 blood transfusion cases in Luzhou City in 2023 were taken as the research objects,and the cost ratio and influencing factors were analyzed by four-quadrant bubble chart and structural equation model.Results:The overall cost ratio of blood transfusion cases was 1.36,the DIP payment rate was 86.40%.The four-quadrant bubble chart showed that most of the top 20 diseases were located in the first quadrant(high proportion of blood transfusion cases and high cost ratio) and second quadrant(low proportion of blood transfusion cases and high cost ratio).The structural equation model showed that the total effect of the influencing factors of the cost ratio of blood transfusion cases was the length of stay(0.623),CMI value(-0.448),blood fee(0.228),discharge mode(0.060),and treatment mode(-0.034).Conclusion:The cost ratio of blood transfusion cases is relatively high,and the risk of overspending under the DIP payment is relatively high.Blood fee and other factors jointly affect the cost ratio of blood transfusion cases.It is recommended that blood transfusion should be included in the minor surgical operation according to resource consumption and used as the basis for disease grouping.In terms of the diseases with a relatively stable cost ratio and a certain proportion of blood transfusion cases,a blood transfusion auxiliary catalogue with blood transfusion indications as the main basis for correction should be constructed to optimize the medical insurance settlement rules for blood transfusion cases.

关 键 词：费用倍率 医保结付率 输血病例 DIP 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]