DRG点数付费对县域医共体建设效果的影响分析

目的:评价DRG点数付费对县域医共体建设效果的影响,以期为县域医共体建设提供依据。方法:选取金华市4个县域医共体和6家市级医院为研究样本,收集医疗服务量、医疗费用负担、医疗收入结构方面的数据,通过指数平滑法预测各测量指标2018—2020年的预测值,运用“投射一实施后”对比分析法比较政策实施前后各级医院测量指标的变化。结果:2019年县级医院平均门急诊量差异度为13.75%,乡镇卫生院平均出院量的差异度为23.08%;2020年县级医院、乡镇卫生院的出院患者平均医药费用差异度分别为-8.59%和-13.92%;2020年县级医院卫生材料收入占医疗收入的比例差异度为-24.86%。结论:DRG点数付费增加了县域内患者的就诊量、降低了住院费用,并优化了县级医院的收入结构,但县域内患者“趋高就医”的问题依然突出、对市级医院的控费效果也不明显,且药品耗材占比仍然较高。建议后续持续完善DRG点数付费的不足之处,强化医保支付方式在县域医共体建设中的引导性作用。

The Influence of DRG Point Payment on the Construction Effect of County Medical Alliance

Objective: It evaluates the effects of DRG point payment scheme on the construction of county medical alliance, in order to provide evidence for the construction and improvement of medical alliance. Methods: A total of 4 county medical alliances and 6 municipal hospitals in Jinhua were selected to collect data on medical service volume, cost burden and income structure. The predicted values of each measurement index from 2018 to 2020 were obtained through the exponential smoothing method. The comparative analysis method of "projection-after implementation" was used to compare the changes of measurement indexes of hospitals at all levels before and after the implementation of the policy. Results: In 2019, the difference in the average number of outpatient and emergency patients in county-level hospitals was 13.75 %, and the difference in the average number of discharged patients in township hospitals was 23.08 %. In 2020, the differences of average hospitalization expenses in county-level hospitals and township hospitals were -8.59 %and -13.92 %, respectively. In 2020, the proportion difference of sanitary materials in county-level hospitals was -24.86 %. Conclusion: DRG point payment has increased the number of patients in the county, reduced hospitalization costs, and optimized the income structure of county-level hospitals. However, county-level patients'' higher medical treatment is still prominent, the effect of cost control on municipal hospitals is not obvious, and the proportion of drugs and consumables is still large. It is recommended to continue to improve the DRG point payment scheme design and strengthen the guiding role of medical insurance payment scheme in the construction of county medical alliance and improve relevant supporting measures.