The Current Situation and Cost Structure Analysis of Extremely High-Cost Cases in Hospitals Under the DRG Payment Method——Taking a Tertiary Hospital in Wuhan City as an Example
Objective:The paper explores the management methods for extremely high-cost cases by analyzing the characteristics of such cases during the 3-year implementation of DRG payment in a tertiary hospital in Wuhan City.Methods:This study focused on the extremely high-cost cases among the DRG cases from January 2021 to December 2023 in a tertiary hospital in Wuhan City.A descriptive analysis was conducted to investigate the basic characteristics and cost structure of these cases.Results:A total of 1585 cases(2.40%)with extremely high costs were identified in the sample hospital during the 3-year period.The age of these patients was 64.00 years(51.00,74.00),and the length of hospital stay was 15.06 days(10.00,24.66).The DRG weight was 0.59(0.30,0.93).The median total hospitalization cost for all patients was 27116.08 yuan.The three individual cost categories that accounted for more than 10%of the total cost were medication costs(22.85%),laboratory test costs(17.94%),and treatment costs(10.32%).The top three MDC with the most cases were MDCB,MDCE,and MDCC.The top three ADRG were BR2,ES2,and CX1.The top three DRG were BR25,ES25,and ES23.Conclusion:The incidence of extremely high-cost cases in the sample hospital is relatively stable,and they are mainly non-difficult and severe disease groups.Although the average hospitalization cost per patient has changed slightly,the key six individual costs have continued to change.Measures such as implementing disease classification management,standardizing clinical pathways,conducting DRG data analysis,and accelerating information construction can be taken to manage the extremely high costs cases.
DRGextremely high-cost casescost structuredistribution of disease
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