摘要
目的研究分析按疾病诊断相关分组(DRG)付费实施对神经系统疾病及功能障碍患者的住院费用及服务的影响,提出推进DRG付费的政策建议。方法利用医院质量监测系统(Hospital Quality Monitoring System,HQMS),在全国东、中、西3个地区的16个省份376家三级医院中选取105550例患者,通过双重差分法分析按DRG付费实施对患者住院费用及服务的影响。结果对于神经系统疾病及功能障碍患者而言,DRG付费的实施,对自付费用(P<0.01)、是否使用抗生素(P=0.03)、31天是否再住院(P=0.01)的影响显著。按DRG付费的实施,使得该组患者自付费用增长了76.83%、使用抗生素者比例降低了1.98%、31天再住院者比例增长了2.02%。按DRG付费的实施,对患者的总费用、医疗费用、药品费用、检查费用、耗材费用、平均住院日和手术概率影响不显著。结论按DRG付费实施对神经系统疾病及功能障碍患者来说,增加了其费用负担,在推广实施DRG过程中应当予以关注。
Objective It analyzed the impacts of DRG payment implementation on hospitalization costs and services in patients with neurological diseases and dysfunction and put forward operational countermeasures and suggestions for the administration.Methods Using a Hospital Quality Monitoring System(HQMS),105550 patients were selected from 376 tertiary hospitals in 16 provinces in the eastern,central,and western regions of China.The impacts of DRG payment on patient hospitalization costs and services were analyzed by the difference in difference(DID).Results For patients with neurological diseases and dysfunction,the implementation of DRG payment has a significant impact on out-of-pocket expenses(P<0.01),whether to use antibiotics(P=0.03),and whether to rehospitalize at 31 days(P=0.01).The implementation of DRG payment increased the out-of-pocket cost by 76.83%(P<0.01),decreased the probability of antibiotic use decreased by 1.98%(P=0.03),and increased the probability of 31-day read hospital by 2.02%(P=0.01).There were no significant effects on the total income of hospitals,medical income,drug income,hospital material income,average hospital days,and operation rate.Conclusion The implementation of DRG payment has certain increase the burden of patients with neurological diseases and dysfunction,more attention should be paid in the process of DRG implementation.
作者
董乾
房耘耘
石学峰
DONG Qian;FANG Yun-yun;SHI Xue-feng(Beijing University of Chinese Medicine,Beijing,100029,China)
出处
《中国医院管理》
北大核心
2021年第11期64-68,共5页
Chinese Hospital Management
