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DRG支付政策实施前后宫颈癌住院患者医疗费用对比分析

Medical Expenses for Hospitalized Patients with Cervical Cancer Before and After the Implementation of the DRG Payment Policy

    摘要
  • 摘要:
    目的 分析公立三甲医院实施按疾病诊断相关分组(diagnosis related group, DRG)支付后, 宫颈癌住院患者的费用变化情况, 为公立医院完善精细化管理措施、提高医保基金使用效能提供参考依据。
    方法 回顾性收集山东省某公立三甲医院2021年4—12月(DRG实施前)及2022年4—12月(DRG实施后)宫颈癌出院患者病例资料。将医保患者作为政策组, 全自费患者作为对照组, 利用双重差分法分析宫颈癌患者住院总费用、药品费用和耗材费用等相关指标在DRG政策实施前后的变化情况。
    结果 共10 383例宫颈癌住院患者纳入本研究, 其中政策组9711例(含DRG实施前5418例, DRG实施后4293例), 对照组672例(含DRG实施前426例, DRG实施后246例)。与DRG实施前相比, DRG实施后两组患者并发症发生率、死亡率、30 d内非计划再住院率和住院时间变化均不明显, 但政策组总费用由11 453.49元下降至8780.94元(降幅为23.33%), 药品费用下降617.37元(降幅为25.17%), 耗材费用下降28.93元(降幅为28.49%); 双重差分法分析结果显示, 政策组比对照组住院总费用较实施前下降了14.40%(R2=0.616, P＜0.05), 药品费用下降了13.80%(R2=0.364, P＜0.01), 耗材费用下降了15.40%(R2=0.565, P＜0.01)。
    结论 DRG政策实施能够在保证临床诊疗规范的基础上, 合理降低病组费用, 实现医疗资源的更有效利用。

     

    Abstract:
    Objective To analyze the cost changes of cervical cancer inpatients after the implementationof diagnosis related group (DRG) payment in public grade-A tertiary hospitals, and to provide reference for public hospitals to improve management strategies and optimize the utilization of medical insurance funds.
    Methods Case data of cervical cancer patients discharged from a public grade-A tertiary hospital in Shandong Province from April to December 2021 (before the implementation of DRG) and from April to December 2022 (after the implementation of DRG) were retrospectively collected. Patients with medical insurance were treated as the policy group and patients with full self-payment were treated as the control group. The changes in the relevant indicators such as total hospitalization costs, drug costs and consumable costs of cervical cancer patients before and after the implementation of the DRG policy were analyzed using the double difference-in-difference (DID) method.
    Results A total of 10 383 hospitalized patients with cervical cancer were enrolled in this study, including 9711 cases in the policy group (including 5418 cases before the implementation of DRG and 4293 cases after the implementation of DRG) and 672 cases in the control group (including 426 cases before the implementation of DRG and 246 cases after the implementation of DRG). Compared with the pre-DRG policy implementation, there were no significant changes in the complication rate, mortality rate, unplanned rehospitalization rate within 30 days, and length of hospital stay between the patients in the policy group and the control group after the DRG policy implementation. However, the total cost of the policy group decreased from ￥11 453.49 to ￥8780.94 (a decrease of 23.33%), in which the cost of medicines decreased by ￥617.37 (a decrease of 25.17%), and the cost of consumables decreased by ￥28.93(a decrease of 28.49%). The results of the double DID mode showed that the total cost of hospitalization in the policy group decreased by 14.40%(R2=0.616, P < 0.05), the cost of medicines decreased by 13.80%(R2=0.364, P < 0.01), and the cost of consumables decreased by 15.40%(R2=0.565, P < 0.01) compared to the control group after the implementation of the DRG policy.
    Conclusions The implementation of DRG policy can reasonably reduce the cost of disease groups and achieve more effective utilization of medical resources on the basis of ensuring accurate clinical diagnosis and high treatment standards.

     

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