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基于DRG付费高倍率病例与正常倍率患者住院费用的比较分析

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目的 探讨高倍率病例费用结构和影响因素。方法 以2023年4月-2024年3月天津市某三级甲等综合医院医保结算数据为研究对象,分析DRG付费的高倍率病例的入组特征,比较分析高倍率病例与正常倍率患者住院费用,采用灰色关联度分析法分析高倍率病例与正常倍率患者住院费用与各类分项费用的灰色关联度。结果 与正常倍率组相比,高倍率组在性别、年龄、医保类型、住院天数、基准点数以及除手术费用外的所有住院费用均存在显著差异(P<0。05)。住院费用结构中,多个DRG组药品费与住院总费用关联最大。总体灰色关联度排序中治疗费关联最高。结论 加强高倍率病例管理,下一步应继续完善高倍率病例和特殊病例单独支付政策,完善临床路径,规范诊疗行为,优化绩效分配办法,加强运营管理,不断提高医保精细化管理。
Comparative analysis of hospitalization costs between high-multiplication DRG Cases and normal-mul-tiplication patients
Objective To explore the cost structure and influencing factors of high-multiplication cases.Methods Using medical insurance settlement data from a tertiary hospital in Tianjin from April 2023 to March 2024,this study analyzes the characteristics of high-multiplication DRG cases and compares hospitalization costs between high-multiplication and normal-multi-plication patients.The grey relational analysis method is employed to assess the grey correlation between hospitalization costs and various itemized expenses for both groups.Results Significant differences were found between the high-multiplication group and the normal-multiplication group in terms of gender,age,insurance type,length of stay,base points,and all hospitalization costs except for surgical expenses(P<0.05).Within the cost structure,drug costs from multiple DRG groups showed the strongest correlation with total hospitalization costs.Treatment costs ranked highest in overall grey correlation.Conclusion Enhancing the management of high-multiplication cases is crucial.Future efforts should focus on improving separate payment policies for high-multiplication and special cases,refining clinical pathways,standardizing medical practices,optimizing performance distribution methods,and strengthening operational management to enhance the fine management of medical insurance.

DRGHigh-multiplication casesHospitalization costsGrey relational analysis

张磊、王蓬、李会明、荣洁

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天津市人民医院 天津 300121

DRG 高倍率病例 住院费用 灰色关联度分析

2024

现代医院
广东省医院协会

现代医院

影响因子:1.332
ISSN:1671-332X
年,卷(期):2024.24(10)