摘要
目的基于医院智能体,对2021年某院按病种分值付费(DIP)成本进行分析,为精细化管控DIP成本提供可行思路。方法在前期医院智能体平台建设及项目成本核算结果的基础上,以2021年度全院60187份病例,4860个DIP病种为研究对象,应用项目叠加法,核算医院全部DIP病种的单位成本。并根据DIP成本核算结果,从DIP病种的划分、全院病种及医保病种的管理、DIP成本纵向与横向对比分析、同一DIP病种下医保病例与非医保病例的管理等角度,对DIP成本精细化管理的思路和方法进行探讨。结果确定了医院DIP优势病种22个,重点病种67个,潜力病种1590个,劣势病种3181个;引入医疗收入作为中间指标,对医保DIP病种的划分进行了探索,确定了医保优势病种1072个,医保重点病种917个,医保潜力病种458个,医保劣势病种815个;通过精细化核算,发现同一DIP病种下非医保病例例均费用普遍高于医保病例,且不同层级DIP成本在不同时间段存在差异。结论通过对全院病种优劣的确定与分析,可以找出同一类别下病种的共性问题,并针对性提出管控手段;通过医保结余和医疗结余两个维度的分析,可以快速确定医保病种的优劣,为医保病种管控提供抓手;对DIP成本横向与纵向对比分析、同一DIP病种下医保病例与非医保病例的分析,可为医院多层次、多维度进行DIP成本管理提供可行方法。
Objective To analyze the cost of diagnosis-intervention packet(DIP)in a certain hospital in 2021 based on hospital intelligent agents,so as to provide feasible ideas for refined management of DIP costs.Methods On the basis of the construction of the hospital intelligent agent platform and the results of project cost accounting in the early stage,a total of 60187 cases and 4860 DIP diseases in the hospital in 2021 were selected as the research objects.The project superposition method was applied to calculate the unit cost of all DIP diseases in the hospital.Based on the results of DIP cost accounting,the ideas and methods of fine management of DIP costs were explored from the perspectives of DIP disease classification,management of all hospital diseases and medical insurance diseases,vertical and horizontal comparative analysis of DIP costs,and management of medical insurance cases and non medical insurance cases under the same DIP disease category.Results Twenty-two advantageous DIP disease types,67 key disease types,1590 potential disease types,and 3181 disadvantageous disease types were identified.Introducing medical income as an intermediate indicator facilitated the classification of DIP disease types under medical insurance,1072 advantageous disease types,917 key disease types,458 potential disease types,and 815 disadvantageous disease types in medical insurance were identified.Through refined accounting,it was found that the average cost of non medical insurance cases under the same DIP disease category was generally higher than that of medical insurance cases,and there were differences in DIP costs at different levels during different time periods.Conclusions By determining and analyzing the advantages and disadvantages of disease types in the entire hospital,common problems of disease types under the same category can be identified,and targeted control measures can be proposed.By analyzing the two dimensions of medical insurance surplus and medical surplus,the advantages and disadvantages of medical insur
作者
江姜
王理国
黎国威
陈淑华
伍平阳
邹春如
田军章
Jiang Jiang;Wang Liguo;Li Guowei;Chen Shuhua;Wu Pingyang;Zou Chunru;Tian Junzhang(Guangdong Second Provincial General Hospital,Guangzhou 510317,China)
出处
《中华医院管理杂志》
CSCD
北大核心
2023年第10期743-748,共6页
Chinese Journal of Hospital Administration
基金
广东省重点领域研发计划(第七批)项目(2020B0101130020)。
关键词
医院
公立
智能体
DIP成本
分析
精细化管理
Hospitals,public
Intelligent agent
DIP cost
Analysis
Refined management
