摘要
目的 探讨临床试验对医保支付的客观影响,为DRG支付方式改革的持续推进提供参考。方法 搜集某肿瘤医院2022年3月15日—2023年3月14日出院的RE1化疗组资料,对超支付限额病例的现状进行描述,并对其影响因素进行logistic回归分析。结果 DRG病例10 971例,其中临床试验组病例占5.42%。临床试验组和非临床实验组超DRG支付限额占比分别为7.56%和25.26%,差异均有统计学意义(P<0.001)。logistic回归分析结果显示,患者进入临床试验,其超支付标准的风险程度降低89.2%,是否靶向治疗、是否静脉置管、住院日、是否免疫治疗、是否多学科会诊、性别依次是病例超支的风险因素。结论 临床试验有助于医院维持医保基金的结余平衡。医院要做好主动管理,为支付制度的完善打好基础。区分联合治疗将是化疗组DRG分组细化的方向。
Objective To explore the objective impact of clinical trials on medical insurance payment in the context of DRG payment,and provide empirical reference for the continuous promotion of payment system reform.Methods Taking the RE1 chemotherapy group of CHS-DRG as an example,a retrospective 1-year data discharged from a certain cancer hospital from March 15,2022 to March 14,2023 was collected to describe the basic situation of cases exceeding the payment limit and to conduct logistic analysis on possible influencing factors.Results A total of10971 DRG settlement cases were collected,of which 5.42% were in the clinical trial group.The proportions of cases exceeding DRG payment criteria in the clinical trial group and non-clinical trial group were 7.56% and 25.26% respectively(P<0.001).Logistic regression analysis result showed that when tumor patients in the chemotherapy group within clinical trial,the risk of exceeding payment standard decreased by 89.2%.Targeted therapy,intravenous catheterization,length of stay,immunotherapy,multidisciplinary consultation and gender were risk factors for exceeding the payment criteria in the RE1 group.Conclusion Clinical trial helps medical institution maintain a balance in the medical insurance fund.Medical institutions need to proactively manage in advance to provide references for the gradual improvement of payment systems.Besides,the combination drug therapy will be the direction of refinement of DRG grouping in the chemotherapy group.
作者
陈治水
冷家骅
刘忆
高明
Chen Zhishui;Leng Jiahua;Liu Yi(Peking University Cancer Hospital&Institute,Beijing,100142,China;不详)
出处
《中国医院管理》
北大核心
2024年第5期31-35,共5页
Chinese Hospital Management
基金
首都卫生管理与政策研究基地开放性课题资助(2023JD01)。
