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基于DRGs的血液病患者住院费用影响研究

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目的 研究按疾病诊断相关分组(diagnosis related groups,DRGs)付费实施对血液病患者住院费用的影响,为医院进行医保精细化管理提供决策依据。方法 从天津市某三甲医院医院信息系统(hospital information system,HIS)中选取 2021 年 10 月—2022 年 3 月和 2022 年 10 月—2023 年 3 月共 21 448 例患者的病历资料,经过倾向得分匹配法进行匹配,筛选出 8 134 例血液病患者,再利用双重差分法分析DRG付费对血液病患者住院费用的影响。结果 实施DRGs付费后,血液病患者的检查费的中位数从 6 306。50 元降至 5 038。50元,自付费用中位数从 7 607。17 元降至 6 562。08 元,材料费的中位数从 305。70 元降至 286。88 元。本研究进一步通过DID分析消除潜在混杂因素的影响,发现自付费用仍下降(P<0。05)。结论 DRGs控费初见成效,有效降低了血液病患者的个人负担,医院应持续关注DRGs的长期效果。
The Effect of DRGs on Hospitalization Cost of Hematology Patients
Objective To analyze the effect of the implementation of diagnosis-related groups(DRGs)on hospitalization cost of hematology patients,and provide the decision basis for hospitals and departments to carry out fine cost management.Methods A total of 21 448 patients were selected from the hospital information system(HIS)of a Class Ⅲ hospital in Tianjin from October 2021 to March 2022 and from October 2022 to March 2023.After matching using propensity scoring matching method,8134 patients with hematological diseases were selected.Then the impact of DRGs payment on hospitalization expenses of hematological patients was analyzed using difference in difference method.Results After implementing DRGs payment,the median examination fee for hematology patients decreased from 6 306.50 yuan to 5 038.50 yuan,the median self expense decreased from 7 607.17 yuan to 6 562.08 yuan,and the median material cost decreased from 305.70 yuan to 286.88 yuan.This study further eliminated the impact of potential confounding factors through DID analysis,and found that self-supporting expenses still significantly decreased(P<0.05).Conclusion The cost control effect of DRGs is beginning to show,reducing the individual burden of hematology patients.Hospitals should continue to pay attention to the long-term effect of DRGs policy.

diagnosis related groupshospitalization costsdifference in differencepropensity scoring matchinghemopathymedical insurance

陈楚涵、张萧红、王宏、杨翼帆、段剑飞、苏丽华

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中国医学科学院血液病医院(中国医学科学院血液学研究所)/血液与健康全国重点实验室/国家血液系统疾病临床医学研究中心/细胞生态海河实验室医保物价科,天津 300020

天津医学健康研究院,天津 301600

疾病诊断相关分组 住院费用 双重差分法 倾向得分匹配 血液病 医保

2024

中国卫生标准管理
《中国卫生标准管理》杂志社

中国卫生标准管理

影响因子:1.374
ISSN:1674-9316
年,卷(期):2024.15(17)