DIP付费骨科住院费构成和总费用研究

A study on the composition and total cost of orthopedic inpatient under diagnosis classification- based payment

摘要:

[目的] 分析骨科参保患者住院费用结构与总费用的关联度，为合理控制骨科患者的住院费用，保障医保基金安全、制约医疗费用不合理增长提供理论依据。[方法] 选取某院骨科 2019 年—2022 年参保患者 7 773 名，依据费用结构的分类，将骨科参保患者住院总费用分为 6 类，针对 6 个评价项以及 6 项数据进行灰色关联度分析，并且以次均费用作为“参考值”，研究 6 个评价项与次均费用的关联关系。[结果]2019 年—2022 年骨科参保患者住院次均费用呈先升后降趋势，但总体呈上升趋势，2020 年涨幅比例最大。药占比趋势同住院次均费用，耗材占比则相反，呈上升趋势。在灰色关联分析中，医保付费前，医疗费的关联度最高。医保付费后，耗材费的关联度最高。其次是医疗费和管理费。[结论]骨科参保患者住院费用医保监管重点应为高值耗材，其次为合理用药和合理收费的监管。同时重视骨科护理人员价值，提高医务人员诊疗积极性。在医院层面重视并逐步探索推进 DIP 支付方式改革，提高医院精细化管理水平。

Abstract:

[Objective] To analyze the correlation between the hospital cost structure and the total cost in insured orthopedic patients to provide a theoretical basis for reasonably controlling the hospital cost of orthopedic patients, ensuring the safety of medical insurance fund and restricting the unreasonable growth of medical cost. [Methods] A total of 7 773 orthopedic patients in a hospital from 2019 to 2022 were included into this study. According to the classification of the cost structure, the total hospitalization cost of orthopedic patients was divided into 6 categories. The gray correlation analysis was conducted for the 6 evaluation items, and the correlation between the six evaluation items and the average cost was studied by taking the average cost of per time as the "reference value". [Results] From 2019 to 2022, the average hospitalization cost of insured orthopedic patients showed a trend of increase first and then decrease, but the overall trend was increasing, and the proportion of increase was the largest in 2020. The trend of the proportion of drugs was the same as the average cost of hospitaliza- tion, but the proportion of consumables was on the contrary, showing an upward trend. In term of grey correlation analysis, medical expenses had the highest correlation before the diagnosis classification-based payment. After the new medical insurance payment, the consumables cost had the highest correlation, followed by medical and administrative costs. [Conclusion] The focus of medical insurance supervision on hospital expenses of orthopedic patients should be on the high-value consumables, followed by rational drug use and reasonable charges. At the same time, we should pay attention to the value of orthopedic nursing staff and improve the enthusiasm of medical staff in diagnosis and treatment. At the hospital level, we should pay attention to and gradually explore and promote the reform of diagnosis intervention packet pay- ment methods, and improve the level of hospital fine management.