摘要
目的:分析海南某市试点医院DRG支付改革实践中取得的成效,为进一步全面铺开DRG支付改革提供依据,丰富CHS-DRG支付改革的实证研究.方法:运用扎根理论和访谈调研法,对某市试点医院2021年7～12月正式实施CHS-DRG付费的基本医疗保险住院病例数据与2020年7～12月按项目付费的病例数据从服务能力、服务效率、住院费用和医疗质量和安全4个维度进行对比分析.结果:某市试点医院在正式实施CHS-DRG支付改革后DRG总组数增加23个组,总权重增加2176.84,CMI增加0.07,平均住院日下降0.54天,平均住院费用下降5.91％,低风险组死亡率降低46.67％,30天内再住院率降低1.82％.结论:医保DRG支付改革带动医疗机构扩大了疾病的诊疗范围,提升了试点医院的医疗服务能力和效率,减少了医药费用的增长,保证了医疗质量和安全,同时也促进了试点医院相关部门管理能力不断提升.
Abstract
Objective:Research and analyze the effectiveness of DRG payment reform in pilot hospitals in Hainan Province,providing a basis for the country to further comprehensively carry out DRG payment reform and enriching empirical research on CHS-DRG payment reform.Methods:Using grounded theory and interview research methods,a comparative analysis was conducted on the inpatient case data of basic medical insurance with CHS-DRG payment officially implemented in pilot hospitals from July to December 2021,and the case data of project payment from July to December 2020 from four dimensions:service capacity,service efficiency,hospitalization expenses,medical quality,and safety.Results:After the implementation of the CHS-DRG payment reform,the pilot hospitals increased the total number of DRG groups by 23,the total weight increased by 2 176.84,the CMI increased by 0.07,the average hospitalization day decreased by 0.54 days,the average hospitalization cost decreased by 5.91％,the mortality rate of the low-risk group decreased by 46.67％,and the readmission rate within 30 days decreased by 1.82％.Conclusion:The reform of medical insurance DRG payment has driven medical institutions to expand the scope of disease diagnosis and treatment,improved the medical service capacity and efficiency of pilot hospitals,reduced the growth of medical fees,ensured medical quality and safety,and promoted the management improvement of pilot hospitals and medical insurance departments.
NETL
NSTL
维普
万方数据