[1]杨业春,李美坤,林 圻,等.“按病种分值付费”控费效果研究[J].卫生经济研究,2021,38(6):36-39.
　YANG Ye-chun,LI Mei-kun,LIN Qi,et al.Study on the Cost Control Effect of "Payment by Disease Score"[J].Journal Press of Health Economics Research,2021,38(6):36-39.
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“按病种分值付费”控费效果研究
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卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
38
期数:
2021年6期
页码:
36-39
栏目:
医保天地
出版日期:
2021-05-28

文章信息/Info

Title:
Study on the Cost Control Effect of "Payment by Disease Score"
作者:
杨业春1; 李美坤1; 林 圻1; 贺嘉嘉1
1.广州中医药大学第一附属医院,广东 广州 510405
Author(s):
YANG Ye-chun;  LI Mei-kun;  LIN Qi;  HE Jia-jia
The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou Guangdong 510405, China
关键词:
疾病诊断相关分组; 按病种分值付费; 住院费用; 病例组合指数
Keywords:
disease diagnosis related group;  payment by disease score;  hospitalization expenses;  case mix index
分类号:
R197
文献标志码:
A
摘要:
目的：分析广州市实施“按病种分值付费”后患者住院费用的变化趋势及差异。方法：以某大型三甲医院2016—2019年286 833例DRG入组病例住院费用为研究样本，通过广义线性模型，校正CMI对住院费用的影响，分析不同病组(ADRG)的住院费用变化趋势是否一致。结果：实施“按病种分值付费”后，广州市医疗保险病例住院费用中位数下降幅度3.15%（P=0.000）;而“其它方式支付”的病例住院费用变化无统计学意义。广义线性模型分析结果显示，矫正CMI值后,仅外科ADRG的住院费用下降有统计学意义，而且是常见病例的住院费用中位数下降，疑难病例反而上升。结论：科学调整各级医疗机构的功能定位和患者诊疗结构；建立分级的病种标准分值库，提高医保补偿的科学性；搭建区域信息平台和数据中心，开展疑难病例和病种耗材专题研究，实施病种耗材的精细化分类管理。
Abstract:
Objective To analyze the changing trend and difference of patients' hospitalization expenses after the implementation of " payment by disease score " in Guangzhou. Methods Taking the hospitalization expenses of 286 833 DRG enrollment case patients in a large tertiary hospital from 2016 to 2019 as the research sample, through the generalized linear model, correct the effect of CMI on hospitalization expenses and analyze whether the changing trend of hospitalization expenses in different disease related groups (ADRG) is consistent. Results After the implementation of " payment by disease score ", the median hospitalization expenses of medical insurance cases in Guangzhou decreased by 3.15%(P=0.000). However, the change of hospitalization expenses of " other payment " cases was not statistically significant. The results of generalized linear model analysis showed that after correcting CMI value, only the hospitalization expenses of surgical ADRG decreased significantly, while the number of difficult cases increased. Conclusion It is necessary to adjust the functional orientation and patient diagnosis and treatment structure of medical institutions at all levels scientifically, establish a classified standard score library of disease types, improve the scientific of medical insurance compensation, build regional information platform and data center, carry out special research on difficult cases and disease consumables, and implement delicacy classified management of disease consumables.

参考文献/References:

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更新日期/Last Update: 2021-05-28