DRG支付下新技术对子宫腔内病变手术的费用影响研究  

Study on the Impact of New Technology on the Surgery Cost for Uterine Cavity Lesions under DRG Payment

作　　者：刘晓坤 朱卫国 孙学勤 张继民 冷志伟 仝佳丽 韩丁 Liu Xiaokun;Zhu Weiguo;Sun Xueqin;Tong Jiali(Medical Insurance Management Office,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing,100730,China;不详)

机构地区：[1]中国医学科学院北京协和医院医疗保险管理处,北京100730 [2]中国医学科学院北京协和医院北京协和医院卫生政策与经济研究平台,北京100730 [3]国家妇产疾病临床医学研究中心,中国医学科学院北京协和医院北京协和医院妇产科,北京100730 [4]中国医学科学院北京协和医院院办公室,北京100730

出　　处：《中国卫生经济》2025年第3期43-46,共4页Chinese Health Economics

基　　金：国家医疗保障局课题(2024P077YW006);国家自然科学基金资助项目数智技术赋能多层次医疗保障下的公立医院运营机制(72441018)。

摘　　要：目的:分析在DRG付费方式下,“经宫腔镜子宫异常组织机械旋切术”这一新技术对“子宫腔内病变手术”DRG组的费用及其结构影响,为制定新技术新项目除外政策提供临床数据支持。方法:选取北京协和医院妇科日间病房2022年3月—2023年11月的按“子宫腔内病变手术”DRG组付费的患者中,使用了“经宫腔镜子宫异常组织机械旋切术”的病例,回顾性分析新技术对病例费用及其结构产生的影响。结果:“经宫腔镜子宫异常组织机械旋切术”在北京市医疗服务价格项目规范中定价为8000元(丙类自费),高于NE19病组支付标准6866元,使用该项新技术显著提高了住院总医疗费用、患者自付比和手术费用,导致患者负担增加以及医院亏损。结论:“经宫腔镜子宫异常组织机械旋切术”具备改善患者预后及加速康复进程、缩短手术时长、规避术中热损伤及缩短医生学习曲线等优势,政策制定者应兼顾费用控制、患者预后和医疗技术发展等因素,科学、审慎地制定新技术除外政策、合理确定支付标准,并做好除外政策与支付标准的更新与联动机制。Objective:To analyze the cost and structural impact of the new technology“transhysteroscopic mechanical rotary excision of abnormal uterine tissues”on the DRG group of“surgery for intrauterine lesions”under the DRG payment method,and to provide clinical data for supporting the development of the exclusion policy for the new technology and new items.Methods:Cases in which transhysteroscopic mechanical rotary excision of abnormal uterine tissues was used in the gynecology day unit of the Peking Union Medcial College Hospital from March 2022 to November 2023,which were paid for under the DRG group of“surgery for intrauterine pathology”,were retrospectively analyzed for the impact of the new technology on the cost and structure of the cases.Results:The price of“transhysteroscopic mechanical rotary excision of abnormal uterine tissues”in the Beijing Medical Service Price Item Specification is 8000 yuan(Class C out-of-pocket expenses),which is higher than the payment standard of 6866 yuan for the NE19 group,and the use of this new technology significantly increased the total hospitalization medical cost,the out-of-pocket ratio of the patients and the surgical cost,which led to an increase in the burden of the patients and the loss of the hospitals.Conclusion:“Transhysteroscopic mechanical rotary excision of abnormal uterine tissue”has the advantages of improving patients'prognosis and accelerating recovery,shortening operation time,avoiding intraoperative thermal injuries,and shortening the learning curve of doctors,etc.Policy makers should take into account cost control,patients'prognosis and the development of medical technology,scientifically and prudently formulate the exclusion policy of the new technology,reasonably determine the payment standard,and make good use of the exclusion policy and the payment standard.

关 键 词：医疗新技术 疾病诊断相关分组 医学发展 费用控制 对策 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] F840.684[经济管理—保险]