Analysis of Influencing Factors and Structural Changes of Hospitalization Cost of Hypertension in the Context of DRG Medical Insurance Payment
Objectives This paper analyzed the factors influencing the cost of hypertension inpatients and the changes of the cost structure in a Three A and Tertiary Hospital under DRG pilot,and provided some reference for the scientific management of hypertension inpatients in hospitals under DRG payment.Methods Non-parametric methods were used to analyze the differences in hospitalization costs among 13006 discharged cases with hypertension as the main diagnosis on the first page of inpatient medical records during the period from January 1st,2020 to December 31st,2022.Multiple step-based regression was used to analyze the influencing factors of hospitalization costs,and the structural changes of hospitalization costs were analyzed through the degree of structural changes.Results The main diagnosis of the inpatient medical records of the study cases was grade 3 hypertension(extremely high risk),and the cases were mainly distributed in cardiovascular related departments and general departments,with a relatively low proportion of surgeries/operations.Laboratory fee and examination fee were the main influencing factors of hospitalization fee,followed by treatment fee,drug fee,bed fee,admission department,operation/operation,pathology fee,nationality,type of medical insurance and main diagnosis.From 2020 to 2022,the average hospitalization cost will decrease by 12.56%;The proportion of examination fee and laboratory fee structure changes positively with the variation degree of 2.54%and 1.21%respectively,while the proportion of pathology fee and drug fee structure changes negatively with the variation degree of-2.76%and-1.28%respectively.The contribution rate of pathological fee structure change was 31.76%.Conclusions The reform of DRG medical insurance payment method could effectively reduce the average hospitalization cost of hypertension patients,but the structure of various expenses in the medical expenses was not reasonable,and the change of various expenses structure in hospitalization expenses was not significant with the advancement of the reform of medical insurance payment method.It was suggested to further improve the types and prices of medical service items,strengthen the management of clinical pathways,and implement the pre-hospital outpatient coordination policy to continuously control the level of medical expenses while optimizing the cost structure.
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