CHS-DRG支付方式下诊断规范化对医院成本控制的效果探讨

目的:探索CHS-DRG支付方式下诊断规范化对医院成本控制的效果。方法:制定医院诊断规范化工作流程,嵌入电子病历,结合CHS-DRG管理系统,让临床科室清晰了解在医保病历上传前的盈亏情况,从而达到影响医疗费用的目的并评估前后效果。结果:诊断规范后临床书写诊断信息准确性较之前有较大改善;样本医院多数科室在诊断规范前后医疗费用降低,且主要体现在药占比和耗占比上;内分泌科在正式实施付费后均次医疗费用继续逐月降低,其他科室未呈现该现象。结论:在CHS-DRG付费制度下,基于临床科室参与匹配ICD编码的诊断规范化,借助DRG管理系统可以帮助内科降低医疗费用,控制医疗成本。为进一步降低医疗费用,着眼手术科室和操作科室,建议将手术/操作也进行规范化。

Analysis on the Effect of Standardized Diagnosis on Hospital Cost Control under CHS-DRG Payment Method

Objective: To explore the effect of standardized diagnosis on hospital cost control under the CHS-DRG payment. Methods: Formulating the workflow of hospital standardized diagnosis, embedding in electronic medical records, and combining with the CHS-DRG management system, so that the clinic can clearly understand the profit and loss situation before the upload of medical insurance cases, so as to achieve the purpose of affecting medical expenses and evaluate the effect before and after the process. Results: The accuracy of clinically written diagnostic information was greatly improved after the standardization of diagnosis; the cost of most sample departments decreased after the standardization, which was mainly reflected in the proportion of drugs and consumption. The cost continues to decrease month by month in Endocrinology, which is not the case in other departments. Conclusion: Under the CHS-DRG payment system, the standardization of diagnosis based on clinical participation in matching ICD codes, with the help of DRG management system, can help internal medicine department to reduce medical expenses and control medical costs. In order to further reduce medical costs, it is recommended to standardize operations by focusing on operating departments.