价值医疗视角下医院按DRG付费制度实施效果分析

目的分析按疾病诊断相关分组(DRG)付费制度下医院行为方式改变和对医院运营管理影响。方法基于价值医疗视角从医疗成本和医疗质量构建指标体系,选择2021年1—4月(实施后)和2019年1—4月(实施前)上海市某妇产科医院病案首页共44 238例数据进行对比分析。结果医疗质量方面,DRG入组率达到了99.87%,全院病例组合指数增长了4.00%,达到了1.04,平均住院日由3.92天下降到3.65天,费用消耗指数由1.51下降到1.16,时间消耗指数由1.02下降到0.99,患者医疗纠纷投诉率由0.19%下降到0.07%。成本方面,DRG总权重增长了8.01%,DRG组数从140组增长到154组,药占比和耗占比保持相对稳定,次均费用由9 780元增长到12 037元。结论按DRG付费制度下试点医院的医疗质量、服务能力和效率同步提升,但是需要进一步加强医疗成本控制,提高精细化运营水平。

Analysis of the Implementation Effect of the DRG Payment System in Hospitals from the Perspective of Value Medicine

Objective Analyze the impact of the implementation of DRG payment system on hospital behavior and hospital operation management. Methods Based on the perspective of value medical care,an indicator system is constructed from two aspects: medical cost and medical quality. Select the data of 44 238 cases on the first page of medical records in a certain obstetrics and gynecology hospital from January to April 2021(after implementation)and January to April 2019(before implementation) for comparative analysis. Results In terms of medical quality,the enrollment rate of DRG increased to 99.87%,the hospital CMI value increased by 4.00% to 1.04,the average hospital stay dropped from 3.92 days to 3.65 days,the cost consumption index dropped from 1.51 to 1.16,the time consumption index dropped from 1.02 to 0.99,and the patient complaint rate for medical disputes dropped from 0.19%to 0.07%. In terms of cost,the total weight of DRG increased by 8.01%,and the number of DRG groups increased from 140 to 154. The proportion of drug costs and medical device costs remained relatively stable,and the average hospitalization cost increased from 9 780 yuan to 12 037 yuan. Conclusion The medical quality,service capabilities and efficiency of pilot hospitals under the DRG payment system have been improved simultaneously. However,it is necessary to further strengthen medical cost control and improve the level of refined operation.