Research on the Impact of Clinical Trials on Medical Insurance Funds:Empirical Analysis Based on the Chemotherapy DRG Groups from a Cancer Hospital in Beijing
Objective To explore the objective impact of clinical trials on medical insurance payment in the context of DRG payment,and provide empirical reference for the continuous promotion of payment system reform.Methods Taking the RE1 chemotherapy group of CHS-DRG as an example,a retrospective 1-year data discharged from a certain cancer hospital from March 15,2022 to March 14,2023 was collected to describe the basic situation of cases exceeding the payment limit and to conduct logistic analysis on possible influencing factors.Results A total of 10 971 DRG settlement cases were collected,of which 5.42％were in the clinical trial group.The proportions of cases exceeding DRG payment criteria in the clinical trial group and non-clinical trial group were 7.56％and 25.26％respectively(P＜0.001).Logistic regression analysis result showed that when tumor patients in the chemotherapy group within clinical trial,the risk of exceeding payment standard decreased by 89.2％.Targeted therapy,intravenous catheterization,length of stay,immunotherapy,multidisciplinary consultation and gender were risk factors for exceeding the payment criteria in the RE1 group.Conclusion Clinical trial helps medical institution maintain a balance in the medical insurance fund.Medical institutions need to proactively manage in advance to provide references for the gradual improvement of payment systems.Besides,the combination drug therapy will be the direction of refinement of DRG grouping in the chemotherapy group.
万方数据
