[1]彭美华,唐超雪,吴婧文,等.医保DRG特病单议病例特征分析及政策优化研究[J].卫生经济研究,2023,40(5):51-54.
　PENG Meihua,TANG Chaoxue,WU Jingwen,et al.Study on Characteristics and Policy Optimization of Separately Discussed Cases under DRG Payment[J].Journal Press of Health Economics Research,2023,40(5):51-54.
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医保DRG特病单议病例特征分析及政策优化研究
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卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
40
期数:
2023年5期
页码:
51-54
栏目:
医疗保障
出版日期:
2023-05-05

文章信息/Info

Title:
Study on Characteristics and Policy Optimization of Separately Discussed Cases under DRG Payment
作者:
彭美华1; 唐超雪1; 吴婧文2; 余丽君2; 许斯略3; 周小林3; 杨 松4; 李锦渊1
1.成都中医药大学管理学院，四川 成都 611137
2.四川省眉山市医疗保障局，四川 眉山 620020
3.上海金仕达卫宁软件科技有限公司，上海 200040
4.成都市三六三医院，四川 成都 610041
Author(s):
PENG Meihua;  TANG Chaoxue;  WU Jingwen;  YU Lijun;  XU Siluo;  ZHOU Xiaolin;  YANG Song;  LI Jinyuan
School of Management, Chengdu University of Traditional Chinese Medicine, Chengdu Sichuan 611137, China
关键词:
DRG; 特病单议; 病例特征; 住院费用
Keywords:
DRG;  separately discussed case;  case characteristic;  hospitalization cost
分类号:
R197
文献标志码:
A
摘要:
目的：分析特病单议病例特征，为医院适应DRG改革及完善特病单议政策提供建议。方法：采集样本城市65家医院2020年DRG特病单议病例5 257例，采用非参数检验方法分析病例特征及费用结构。结果：耗材费用、医疗机构等级、患者年龄、住院天数、入院情况、有无手术操作、其他诊断个数等是导致住院费用过高的重要因素，特病单议政策有利于保护急症、重症、老龄、慢性病等患者权益，可弥补DRG付费的内生缺陷。结论：完善特病单议政策，健全申诉沟通机制，避免费用掩盖技术创新，扩围集采和国谈的药耗品类，加快价格改革，落实合理补偿。
Abstract:
Objective To analyze the characteristics of distribution and cost of separately discussed cases under DRG payment, and to provide countermeasures for the improvement of separately discussed cases policy. Methods A total of 5 257 separately discussed cases under DRG payment were collected from 65 hospitals in the sample city in 2020. Non-parametric tests were used to analyze the characteristics and cost structure of the cases. Results Consumables expenses, level of medical institution, patient age, length of stay, admission conditions, presence or absence of surgical operations, and number of other diagnoses are important factors that contribute to excessive hospitalization costs. The policies of separately discussed cases are conducive to protecting the rights of patients with acute, severe, elderly, and chronic diseases, and can compensate for the endogenous defects of DRG payment. Conclusion It is necessary to improve the policy of separately discussed cases, strengthen the mechanism of complaint communication, avoid using expenses to cover up technological innovation, expand the scope of centralized procurement and nationally negotiated drugs and consumables categories, accelerate price reform, and implement reasonable compensation.

参考文献/References:

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更新日期/Last Update: 2023-05-05