公立医院DRG病组成本-效益分析探索*

目的：为适应医改变化，提升医院精细化管理水平，进一步强化业财融合，为医院病种结构优化和专科发展方向提供参数依据，为DRG预付费改革提供数据参考。方法：运用作业成本法、项目叠加法和象限分析法，开展基于DRG病组的成本核算与效益分析。结果：生成院、科两级DRG病组及相关医疗、财务关键数据；通过院级专科和DRG病组的象限划分区别优劣类型，实施战略分析；随着病种并发症和伴随症的发生以及严重程度加深，住院平均天数、CMI升高，病种效益下降。结论：典型病组(专病)专科专治，效益更具优势；现行医疗服务项目价格与国家病种付费及分级诊疗改革方向存在差距；对DRG病组效益分析、象限分析和收支来源进行解读，呼吁杜绝医疗浪费、控制成本消耗，促进临床诊疗与经济运营的结合，获得临床科室的认可，起到了为临床提示病种结构优劣调整和专科建设发展方向的作用。

Practice and Discussion on Cost-Benefit Analysis of DRG in Public Hospitals

Objective: To adapt to the change of medical reform, improve the level of delicacy management of hospitals and further strengthen the integration of operation and finance, so as to provide parameter basis for the structural optimization of hospital diseases and the direction of specialties development, as well as the data references for the reform of DRG pre-payment. Methods: It carried out cost accounting and benefit analysis based on DRG disease group by using methods of activity-based cost method, project superposition method and quadrant analysis. Results: The key data of medical and financial of hospital and department levels were showed. With the quadrant division of specialties and DRG, strategic analysis was given to conduct the strategy analysis. With the increase of disease complications, concomitant disease and its severity, the average length of stay in hospital and CMI increased, whilethe benefit of disease classification decreased. Conclusions: As a conclusion, the treatment of typical disease group is more effective and there is still a gap between the current pricing of medical services and the direction of the national hierarchical medical reform. The discussion is also focus on benefit analysis, quadrant analysis and sources of income and expenditure of DRG. In addition, it calls for the elimination of medical waste, the control of cost consumption and promotion on combination of clinical diagnosis and treatment and economic operation, which plays a role in guiding the adjustment of disease structure and the development direction of specialty construction to a certain degree.