摘要
目的在比较广西某市医院实施疾病诊断相关分组(DRG)付费前后脑梗死患者住院费用结构变化的基础上,分析DRG对脑梗死患者住院费用的影响因素。方法收集广西某市医院2019年与2021年脑梗死住院患者病案资料,采用结构变动度分析和灰色关联分析等研究方法,对住院费用及其影响因素进行深入的分析和探讨。结果实行DRG付费后脑梗死患者出院人次增加,平均住院时间减少,总住院费用上升;脑梗死患者住院费用结构变化明显,药费占比大幅度下降,检查费呈上升趋势;关联度及关联序列排前三位的分别是药费、检查费、化验费;非参数检验结果表明,性别、年龄、医保类型、有无输血、有无手术、住院时间对脑梗死患者住院费用均有显著影响(P<0.05)。结论该院DRG付费改革观念未转,成本控制意识弱;费用结构优化后,药费占比仍高,检查费占比上升,技术劳务价值占比较低;住院时间对脑梗死患者费用影响大,时间越长费用越高。
Objective On the basis of analyzing the changes in the hospitalization cost structure of stroke patients before and after the implementation of diagnosis related groups(DRG)in a hospital in a certain city of Guangxi,to analyze the influencing factors of DRG on hospitalization expenses for patients with cerebral infarction.Methods The medical records of hospitalized patients with cerebral infarction in a certain city in Guangxi in 2019 and 2021 were collected.Structural change analysis and grey relational analysis were used to conduct in-depth analysis and discussion on hospitalization costs and their influencing factors.Results After the reform of DRG,the number of discharged patients with cerebral infarction was increased,the average length of hospital stay was decreased,and the total hospitalization costs was increased.The cost structure of hospitalization expenses for patients with cerebral infarction was significantly changed,with a significant decrease in drug costs and an upward trend in examination fees.The top three factors in the correlation and correlation sequence were drug costs,examination fees,and laboratory fees.Non-parametric test results showed that gender,age,type of medical insurance,blood transfusion,surgery,and length of hospital stay had significant effects on the hospitalization costs of patients with cerebral infarction(P<0.05).Conclusion This hospital′s DRG payment reform concept has not changed,and the awareness of cost control is weak.After optimizing the cost structure,the proportion of medication fees in this hospital remains high.The increase in the proportion of inspection fees in this hospital needs attention,and the value of technical labor services is relatively low.The length of hospitalization has a significant effect on the hospitalization expenses of stroke patients,with longer hospitalization days leading to higher hospitalization expenses.
作者
诸葛秀红
覃双凌
唐宗英
严文君
ZHUGE Xiuhong;QIN Shuangling;TANG Zongying;YAN Wenjun(Department of Medical Insurance and Medical Record,Affiliated Hospital of Guilin Medical University,Guilin 541001,China;College of Humanities and Management,Guilin Medical University,Guilin 541199,China;People′s Hospital of Wuzhou City,Wuzhou 543001,China)
出处
《华夏医学》
CAS
2024年第5期82-88,共7页
Acta Medicinae Sinica
基金
广西壮族自治区卫生健康委员会科研项目(Z20211006)
桂林医学院哲学社会科学研究项目(2021sk006)。
关键词
脑梗死
疾病诊断相关分组付费
住院费用
cerebral infarction
diagnosis related groups
hospitalization expenses
