[1]丁敬美,蔡 洁,胡雪军,等.DRG病组权重和倍率对外科组患者高自付费用的影响及机制研究[J].卫生经济研究,2026,43(09):84-89.
　DING Jingmei,CAI Jie,HU Xuejun,et al.Study on the Impact and Mechanisms of DRG Weight and Cost Multiplier on High Out-of-Pocket Expenses in Surgical Patients[J].Journal Press of Health Economics Research,2026,43(09):84-89.
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DRG病组权重和倍率对外科组患者高自付费用的影响及机制研究

卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
43
期数:
2026年09期
页码:
84-89
栏目:
医疗保障
出版日期:
2026-09-02

文章信息/Info

Title:
Study on the Impact and Mechanisms of DRG Weight and Cost Multiplier on High Out-of-Pocket Expenses in Surgical Patients
作者:
丁敬美1; 蔡 洁1; 胡雪军2; 李 敏1
1.中国人民解放军中部战区总医院，湖北 武汉 430000
2.中国人民解放军空军军医大学，陕西 西安 710043
Author(s):
DING Jingmei;  CAI Jie;  HU Xuejun;  LI Min
General Hospital of Central Theater Command, Wuhan Hubei 430000, China
关键词:
DRG支付; 权重; 倍率; 外科组患者; 自付比例; 自付费用
Keywords:
DRG payment;  weight;  cost multiplier;  surgical patients;  out-of-pocket ratio;  out-of-pocket expenses
分类号:
R197
文献标志码:
A
摘要:
目的：探讨DRG病组权重和倍率对外科组患者高自付费用的影响及机制，为优化DRG政策提供参考依据。方法：选取某三甲医院2023—2024年21 153例外科组DRG病例，采用单因素分析与二元Logistic回归分析，识别产生高自付费用的影响因素，构建中介与调节效应模型，探讨费用结构在其中的作用机制。结果：DRG支付下外科组患者发生高自付费用的影响因素多元，包括住院天数、并发症与合并症情况、参保类型及费用结构；DRG病组权重和倍率是外科组患者发生高自付费用的强风险因素，病组权重每增加1单位，高自付概率增加16.5倍；倍率每增加1单位，高自付概率增加544.36倍。结论：病组权重通过耗材、手术、检验检查费用占比的中介效应影响高自付；倍率则通过费用结构的调节效应影响高自付，其中，药品、治疗费用占比提高会增强倍率对高自付的正向影响，而检验检查和手术费用占比提高则会削弱这一影响。这些发现为医院管理者和政策制定者从优化费用结构角度完善DRG支付政策提供了重要参考依据。
Abstract:
Objective To investigate the impact of DRG weight and cost multiplier on high out-of-pocket expenses in surgical patients and its underlying mechanisms, providing references for optimizing DRG policies. Methods A total of 21 153 DRG cases in surgical groups from a tertiary hospital during 2023-2024 were selected. Univariate analysis and binary logistic regression were used to identify factors associated with high out-of-pocket expenses, and mediation and moderation models were constructed to explore the role of cost structure in the mechanisms. Results Multiple factors influenced high out-of-pocket expenses under DRG payment, including length of stay, complications and comorbidities, insurance type, and cost structure. DRG weight and cost multiplier were strong risk factors for high out-of-pocket expenses: each unit increase in weight increased the probability of high out-of-pocket costs by 16.5 times, and each unit increase in cost multiplier increased the probability by 544.36 times. Conclusion DRG weight affects high out-of-pocket expenses through the mediation effect of the proportions of consumables, surgery, and diagnostic costs; cost multiplier affects high out-of-pocket expenses through the moderation effect of cost structure, with higher proportions of drug and treatment costs strengthening the positive effect of multiplier on high out-of-pocket expenses, while higher proportions of diagnostic and surgery costs weakening this effect. These findings provide important references for hospital administrators and policymakers to optimize DRG payment policies from the perspective of cost structure adjustment.

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更新日期/Last Update: 2026-09-02