目的: 对DRG付费下某三甲综合医院临床科室的公平与效率进行综合评价,为DRG支付方式改革的完善提供建议。方法: 建立评价指标体系,采用熵权-TOPSIS与RSR法结合得出样本的各项指标权重和优劣排序。利用数据包络分析（Data Envelopment Analysis,DEA）探索科室DRG效率情况。采用四分图模型对公平与效率结果进行可视化分析。结果: 指标权重排名前两位的是DRG权重和费用消耗指数。病种RSR分档结果为好（>0.73）、中（0.33—0.73）、差（<0.33）,科室RSR分档结果为好（>0.80）、中（0.27—0.80）、差（<0.27）,集中在“中档”的科室和病种均占比83%。临床科室效率评价中综合效率均值为0.858,纯技术效率均值为0.581,规模效率均值为0.965,仅有1个临床科室达到DEA相对有效。结论: 病种和科室间公平性和效率存在差异,DRG付费改革需兼顾公平与效率,细化和完善病种,优化资源配置,促进医院的精细化管理。

Objective: The paper comprehensively evaluates the equity and efficiency of the clinical department of a Class III hospital under DRG payment, and provides suggestions for the improvement of DRG payment method reform. Methods: The evaluation index system was established, and the entropy weight-TOPSIS and RSR methods were combined to determine the weight and ranking of each index of the sample. The efficiency of the department was explored by Data Envelopment Analysis (DEA) under DRG. The four-quadrant graph model was used to visualize and analyze the equity and efficiency results. Results: The top two evaluation indicators were DRG weight and cost consumption index. The results of RSR grading for disease types were good (>0.73), medium (0.33-0.73), and poor (<0.33). The results of RSR grading for departments were good (>0.80), medium (0.27-0.80), and poor (<0.27). 83% of the departments and diseases are concentrated in the "mid-range". The mean value of comprehensive efficiency in the efficiency evaluation of clinical departments was 0.858, the mean value of pure technical efficiency was 0.581, the mean value of scale efficiency was 0.965, and only one clinical department reached DEA relative effectiveness. Conclusion: There are differences in equity and efficiency between disease types and departments. DRG payment reform needs to balance equity and efficiency, refine and improve disease types, optimize resource allocation, and promote fine hospital management.