DRG高倍率病例住院费用结构及影响因素分析
Analysis of Hospitalization Cost Structure and Influencing Factors of DRG High-Rate Cases Sampled with A Terti-ary Hospital in Chongqing
谭博文 1张伟 2蒋祎1
作者信息
- 1. 重庆医科大学公共卫生学院,重庆 400000
- 2. 重庆医科大学附属第一医院
- 折叠
摘要
目的:深入分析按疾病诊断分组(DRG)付费下高倍率病例的入组特征,探究其住院费用的内部结构及影响因素,为医疗保险部门和医疗机构提供决策参考,以控制高倍率病例数量、降低医疗费用.方法:收集重庆市某三甲医院2023 年2 362 例高倍率病例,对DRG高倍率病例的入组特征进行描述性分析;采用灰色关联分析探究高倍率患者住院费用与其内部各项费用之间的关联度;采用单因素分析、多元线性回归和随机森林模型,综合分析高倍率患者住院费用的影响因素及其重要程度.结果:与正常倍率病例相比,高倍率病例的住院时间更长,住院费用更高,患者年龄更大,但相对权重(RW)更低.高倍率病例住院费用灰色关联分析相关度前 3 位依次为化验费、检查费和药品费.住院天数、并发症情况和手术等级是高倍率病例住院费用的主要影响因素.结论:医保局应优化高倍率病例认定标准和DRG的分组标准;医疗机构应优化临床路径和诊疗流程,并加强费用管理.
Abstract
Objective To deeply analyze the enrollment characteristics of high-rate cases under the payment by disease diag-nosis grouping(DRG),explore the internal structure of their hospitalization costs and their influencing factors,and provide deci-sion-making references for the health insurance department and healthcare institutions.Methods 2 362 high-rate cases were col-lected from a tertiary hospital in Chongqing in 2023.Descriptive analysis of their enrollment characteristics was conducted.Gray correlation analysis was used to explore the correlation among the hospitalization costs of high-rate patients and their internal costs.One-way analysis,multivariate linear regression,and the random forest model were used to comprehensively analyze the influencing factors of the hospitalization costs of high-rate patients and their importance degree.Results Compared with normal-multiplicity cases,high-rate cases had longer hospital duration,higher hospitalization costs,and older patients,but lower rela-tive weights(RW).The top 3 correlations in gray correlation analysis of hospitalization costs for high-rate cases were ranked as laboratory fees,examination fees,and drug fees.The number of days of hospitalization,complication status,and grade of surgery were the main influencing factors of hospitalization costs for high-rate cases.Conclusion Medical insurance bureau should opti-mize the criteria for identifying high-rate cases and grouping criteria for DRG.Medical institutions should optimize the clinical pathway and diagnostic and treatment process,and strengthen the cost management.
关键词
DRG/高倍率病例/住院费用/费用结构/影响因素Key words
DRG/high-multiplicity cases/hospitalization cost/cost structure/influencing factors引用本文复制引用
出版年
2025
NETL
NSTL
万方数据