[1]杨若宁,任晓红,廖藏宜,等.DRG付费下特殊病例的影响因素研究[J].卫生经济研究,2024,41(11):44-49.
　YANG Ruoning,REN Xiaohong,LIAO Zangyi,et al.Study on Influencing Factors of Special Cases under DRG Payment[J].Journal Press of Health Economics Research,2024,41(11):44-49.
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DRG付费下特殊病例的影响因素研究
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卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
41
期数:
2024年11期
页码:
44-49
栏目:
医疗保障
出版日期:
2024-10-31

文章信息/Info

Title:
Study on Influencing Factors of Special Cases under DRG Payment
作者:
杨若宁1; 2; 任晓红2; 廖藏宜1; 3; 周 宁2; 张敬华2
1.广西医科大学人文社会科学学院，广西 南宁 530000
2.南京中医药大学附属南京中医院，江苏 南京 210022
3.中国政法大学政治与公共管理学院，北京 100080
Author(s):
YANG Ruoning;  REN Xiaohong;  LIAO Zangyi;  ZHOU Ning;  ZHANG Jinghua
Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine, Nanjing Jiangsu 210022, China
关键词:
DRG; 特殊病例; 高倍率病例; 低倍率病例
Keywords:
DRG;  special cases;  high rate cases;  low rate case
分类号:
R19
文献标志码:
A
摘要:
目的：分析DRG付费下特殊病例的影响因素，为优化DRG分组、完善医保政策提供实证参考。方法：以样本医院2022年DRG入组病例为研究对象，对特殊病例及其分布进行统计描述，与正常病例进行单因素对比分析，并采用Logistic多元回归分析特殊病例影响因素。结果：患者年龄、性别、住院天数、主操作是否为中医技术操作、药占比、耗占比、医疗服务项目与设施占比、RW值、离院方式、合并症并发症伴随情况，是发生特殊病例的主要影响因素。结论：医院应借助DRG支付工具，加强院内特殊病例费用超支风险管控；医保部门应完善支付政策，最大化保障分组方案公平性，减少特殊病例的发生。
Abstract:
Objective To analyze the influencing factors of special cases under DRG payment, and to provide empirical reference for optimizing DRG grouping and improving medical insurance policies. Methods Taking the enrolled cases of DRG in sample hospitals in 2022 as the research object, the special cases and their distribution were statistically described, and were compared with normal cases by single factor analysis. The influencing factors of special cases were analyzed by logistic multiple regression. Results The age, gender, length of stay, whether the main operation was TCM technical operation, drug proportion, consumption proportion, medical service items and facilities proportion, RW value, discharge mode, and complications were the main factors affecting the occurrence of special cases. Conclusion Hospitals should use DRG payment tools to strengthen the risk control of cost overruns for special cases within the hospital. The medical insurance departments should improve the payment policies, maximize the fairness of the grouping schemes and reduce the occurrence of special cases.

参考文献/References:

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更新日期/Last Update: 2024-10-31