目的: 探究DRG支付方式改革背景下医疗机构住院服务情况,为医疗机构医保精细化管理提供理论依据;同时以专科医疗机构的视角为完善医保支付方式改革政策提供建议。方法: 运用主成分分析法,以2021年11月—2022年9月天津市某三级专科医疗机构DRG付费数据为基础,结合12个管理指标进行统计分析,对25个临床科室进行综合得分评价。结果: 巴特利特球形检验显著性P<0.001,KMO统计量为0.681,适合进行主成分分析,将收治疾病难度、收治疾病广度、运营管理效率以及运营管理质量4个主成分因子作为综合评价指标,计算发现综合得分较高的科室多为技术价值较高的临床科室。结论: 医保支付方式改革对医疗机构自身建设和运营管理能力提出了更高要求,专科医疗机构不仅要重点发展优势学科、优化病种管理、提升技术价值,更要积极控制医疗总费用、降低患者个人负担、提高病历书写质量与医疗服务满意度、提升竞争优势。随着医保支付方式改革的推进,医保部门和医疗机构可以利用数据挖掘技术,探索建立与DRG支付方式相匹配的评价体系,提高运行效率,促进医疗机构高质量发展。

Objective: The paper explores the inpatient services in medical institutions under the background of DRG payment reform to provide theoretical basis for the refined management of medical insurance in medical institutions. At the same time, it provides suggestions for improving the reform policy of medical insurance payment from the perspective of specialized medical institutions. Methods: Based on the DRG payment data of a tertiary specialized medical institution in Tianjin from November 2021 to September 2022, the principal component analysis method was used to conduct a statistical analysis with 12 management indicators, and the comprehensive scores of 25 clinical departments were evaluated. Results: The significance of Bartlett's Test of Sphericity was P<0.001, and the KMO statistic was 0.681, which was suitable for principal component analysis. The four principal component factors of diseases complexity, diseases types, efficiency of operation management, and quality of operation management were taken as comprehensive evaluation indicators. The departments with high comprehensive scores were mostly clinical departments with high technical value. Conclusion: The reform of medical insurance payment mode requires highly in construction and operation management ability of medical institutions. Specialized medical institutions should not only focus on the development of dominant disciplines, optimize disease management and enhance technical value, but also actively control the total medical cost, reduce the patients' burden, improve the quality of medical record and medical service satisfaction, and enhance competitive advantages. With the advancement of the reform of medical insurance payment methods, medical insurance departments and medical institutions can use data mining technology to explore the establishment of an evaluation system that matches the DRG payment model, in order to improve operational efficiency, and promote the healthy development of medical institutions.