摘要
目的:基于DRG结算信息,对产科系统进行病种及费用分析,并对产科各科室绩效进行评价,为医院精细化管理提供依据。方法:基于国家医疗保障疾病诊断相关分组(CHS-DRG)北京版细分组方案(1.1版ICD2.0),对北京某三甲妇产专科医院产科病房2022年3月15日至2022年7月31日纳入实际DRG付费的1468例患者的分组付费结果进行费用分析,通过DRG组数、病例组合指数(CMI)、费用消耗指数、时间消耗指数等指标对该院产科系统医疗服务绩效进行评价,并对未纳入DRG实际付费的剖宫产患者进行DRG结算分析。结果:(1)该院产科收治病种共10个DRG组别,CMI值为0.136。(2)10个DRG组别中,4个组别的次均费用高于全市平均水平,分别为OC19、OD19、OF29、OS29,按DRG结算后,3个组别结余为负,分别为OC19、OD19、OS29,其中OC19亏损最多。(3)该院产科共6个科室,A科室、D科室、E科室及F科室的CMI值高于全院平均水平,A科室和C科室的时间消耗指数和费用消耗指数均小于1,效率最高。(4)按定额付费的剖宫产患者,若按DRG标准付费后,各科室结余均较之前明显增加;按项目付费的剖宫产患者,若按DRG标准付费后,除A科室次均略有结余外,其余科室均亏损,次均亏损最高可达932.32元。结论:通过DRG付费可以将该院产科与全市平均费用进行比较,有利于医院精细化管理,使用DRG指标对各科室进行绩效评价能够客观、公正地评价其医疗能力与效率,有助于提升科室服务质量。
Objective: Based on the DRG official billing information, we analyzed the cases and costs of obstetric system, and evaluated the performance of each obstetric department to provide a basis for hospital refinement management. Methods: Based on the Beijing version of the CHS-DRG subdivision grouping scheme(version 1.1, ICD 2.0), the cost analysis was performed on the grouping payment results of 1468 patients who were included in the actual DRG payment from March 15, 2022 to July 31, 2022 in a grade 3A obstetrics and gynecology specialty hospital in Beijing. The DRG group number, case mix index(CMI), cost consumption index and time consumption index were used to evaluate the hospital’s obstetric system medical service performance. The cesarean section cases, which were not included in the actual DRG payment, were analyzed by DRG. Results:(1) A total of 10 DRG groups were admitted to our obstetrics department with a CMI of 0.136.(2) Among the 10 DRG groups,4 groups of OC19, OD19, OF29 and OS29, had a sub-average cost higher than the city average. After billing by DRG, 3 groups of OC19, OD19 and OS29, had a negative balance, with group OC19 having the largest deficit.(3)There were 6 departments in our obstetrics department, among which the CMI values of Department A, D, E and F were higher than the hospital average. The time consumption index and cost consumption index of Department A and C were less than 1, with the highest efficiency.(4) For cesarean patients paid by fixed amount, if paid according to DRG standard, the balance of each department was significantly higher than before. For patients with cesarean sections paid fee-for-service, when paid at the DRG rate, all departments made a loss, except for Department A,which has a slight average surplus, with an average loss up to 932.32 yuan. Conclusion: Through DRG payment, the obstetrics department of our hospital can be compared with the city’s average cost, which is conducive to hospital fine management. Using DRG indicators to evaluate the performance of ea
出处
《中国医疗保险》
2022年第10期97-101,共5页
China Health Insurance
关键词
DRG
产科
病例组合指数
绩效评价
DRG
obstetrics
case mix index
performance evaluation
