目的: 分析深圳市某三甲医院实施按病种分值付费（Diagnosis-Intervention Packet, DIP）为基础的病种成本管理的进展与成效,总结相关成本管理实践经验。方法: 选取放射治疗科和肿瘤内科2021年—2023年第一季度21507例患者纳入的5249个病种分组,采用时间序列分析法对DIP相关成本数据进行描述性和统计学分析。结果: 截至2023年第一季度,两个科室的病种次均DIP收入与项目收入差额、病种次均DIP收支结余均实现由亏转盈;人均住院总费用、医疗服务费用、检查费用和化验费用均具有正向反馈（P<0.05）,一定程度上实现了成本管理效果。C34.0、C54.1、C78.2、Z08.0和Z51.1病组盈亏与实施DIP成本管理具有相关性,且各病组盈利率均有所提高。结论: 以DIP为基础的病种成本管理可以提高病种入组准确率,实现病种次均DIP收入高于项目收入、次均DIP收支盈余,有效管理医疗费用并提高病种盈余率。研究结果对于理解和推动以DIP为基础的病种成本管理在国内的实践具有一定参考价值。

Objective: The paper analyzes the implementation and effectiveness of DIP-based disease cost management in a first-class hospital in Shenzhen, and summarizes the practical experience in cost management. Methods: A total of 21507 patients included in 5249 disease groups in radiotherapy and oncology departments from 2021 to the first quarter of 2023 was collected, and time series analysis was used to make the descriptive and statistical analysis of DIP cost data. Results: By the first quarter of 2023, the difference between the average DIP revenue and the average project revenue, and the average DIP income and expenditure balance of the two representative departments all turned from deficit to surplus. The total per capita hospitalization cost, medical service cost, examination cost and laboratory cost have positive feedback (P < 0.05), and the cost was to some extent managed. The profit and deficit of the disease groups with diagnosis of C34.0, C54.1, C78.2, Z08.0 and Z51.1 were correlated with the implementation of DIP cost management, and the profit rate of each disease group increased. Conclusion: The implementation of DIP-based disease cost management can improve the accuracy of disease enrollment, achieve higher average DIP income than the project income of diseases and the average DIP income and expenditure surplus, and effectively manage medical expenses and improve the surplus rate of diseases. This study can be a reference for understanding and promoting the practice of DIP-based disease cost management in China.