DRG对住院费用与服务的影响及建议

目的分析实施DRG付费对患者住院费用及服务的影响，为医疗机构提出运行建议。方法利用医院质量监测系统（HQMS），在全国东部、中部、西部3个地区的16个省（市）376家三级医院中选取患者1 064 314人次，通过双重差分法分析DRG付费实施对患者住院费用及服务的影响。结果DRG付费实施后，患者总费用降低了3.05%（β=1-e-0.03，P=0.01）、自付费用增长了28.11%（β=e0.33-1，P=0.02）、医疗费用降低了5.13%（β=1-e-0.05，P=0.04）、药品费用降低了5.13%（β=1-e-0.05，P=0.01）、平均住院日缩短了4.08%（β=1-e-0.04，P＜0.01），而对患者住院检查费用、耗材费用、是否使用抗生素、31天是否再住院、是否手术的影响不显著。结论实施DRG付费能够合理控制患者住院费用增长，提高医疗服务质量，建议医疗机构进一步简化流程，提高床位周转率，关注高CMI值患者费用，优化临床路径，确保治疗效果。

The Impact of DRG on Hospitalization Costs and Services and Recommendations

ObjectiveTo analyze the impact of DRG payment implementation on patients' hospitalization costs and services, and put forward operational suggestions for medical institutions. MethodsUsing Hospital Quality Monitoring System (HQMS), 1 064 314 patients were selected from 376 tertiary hospitals in 16 provinces in the eastern, central and western regions of China. The impact of DRG payment on patient hospitalization costs and services was analyzed by difference in difference (DID). ResultsThe implementation of DRG payment reduced the total cost of patients by 3.05% (β=1-e-0.03，P=0.01), increased the out-of-pocket cost by 28.11% (β=e0.33-1，P=0.02), and reduced the medical cost by 5.13% (β=1-e-0.05，P=0.04), drug cost decreased by 5.13% (β=1-e-0.05，P=0.01), and average hospitalization days decreased by 4.08% (β=1-e-0.04, P＜0.01). There was no significant effect on the cost of in-hospital examination, the cost of supplies, the use of antibiotics, the rehospitalization after 31 days, and the operation. Conclusion The implementation of DRG payment can control the increase of hospitalization cost and improve the quality of medical service. It is suggested that medical institutions further simplify the process, improve the bed turnover rate, pay attention to the cost of patients with high CMI value, optimize the clinical pathway and ensure the treatment effect.