目的 分析DRG支付方式改革对县级公立医院次均住院费用的影响，为该政策在县域的进一步推广实施提供循证证据和政策建议。方法 收集2017—2022年浙江省玉环市所有综合公立医院住院患者的首页病案数据，通过描述性分析、结构变动度分析和间断时间序列分析对比改革前后次均住院费用结构的变化。结果 医疗服务费用年均结构变动值(Value of Structure Variation，VSV)从1。21％增长到1。49％，占比正向变动幅度增加;药品费用降速放缓(P<0。05)，年均VSV从-2。96％增长到-2。46％，占比负向变动的幅度减小;耗材费用增长趋势停止(P<0。05)，年均VSV从1。98％减少到1。30％，占比正向变动的幅度减小。结论 DRG支付方式改革可以改善县级公立医院次均住院费用结构，使医疗服务费用占比上升。建议重视技术劳务价值，控制耗材费用增长，加强DRG绩效考评机制和医疗服务质量监督机制建设。
Research on the Effect of the DRG Payment Reform on the Structure of Average Hospitalization Expenses in County Public Hospitals
Objective To analyze the effect of DRG payment reform on the average expenses of hospitalization in county public hospitals,and to provide evidence and policy recommendations for the promotion and implementation of this policy in the county.Methods Medical record home page of inpatients in all comprehensive public hospitals in Yuhuan County,Zhejiang Province,were collected from 2017 to 2022,and the changes in the structure of average hospitalization expenses before and after the reform were compared through the descriptive analysis,Degree of Structure Variation analysis and Interrupted Time Series analysis.Results The annual Value of Structure Variation (VSV) of medical service expense increased from 1.21％ to 1.49％,accounting for the increase in the positive change of the proportion;the deceleration of the drug expenses slowed down (P<0.05),with the annual VSV increasing from-2.96％ to-2.96％,accounting for a decrease in the magnitude of the negative change in the ratio;the trend of growth in the expenses of consumables ceased (P<0.05),and the annual VSV decreased from 1.98％to 1.30％,accounting for a decrease in the magnitude of the positive change in the ratio.Conclusion The DRG payment reform can enhance the structure of average inpatient expenses in county-level public hospitals,resulting in an increased proportion of medical service expenses.It is advisable to prioritize the valuation of technological labor services,control the growth of consumables expenses,and strengthen the establishment of DRG performance evaluation mechanisms,as well as quality supervision mechanisms for medical services.
DRGcounty public hospitalsaverage hospitalization expenseDegree of Structure VariationInterrupted Time Series analysis
万方数据
维普
