目的: 通过DIP支付方式下中医优势病种住院费用的关联分析,为进一步推动中医优势病种支付方式改革提供参考。方法: 利用Apriori算法对中医优势病种住院患者相关数据进行关联挖掘。结果: 多项指标与实际分值费用、结余和参保人负担三者的关联关系较强。病种分类、化验费、检查费、药费、总费用与实际分值费用的关联关系较强;病种分类、参保人费用负担、化验费、检查费、药费、总费用与结余的关联关系较强;病人（医保）类型、化验费、药费与参保人负担的关联关系较强。结论: DIP付费与中医优势病种结合良好,符合医、保、患三方利益,但也存在不同医保类型的患者获得感差距较大的问题。
Abstract
Objective: This paper discusses the correlation analysis of the hospitalization expenses of TCM dominant diseases under the DIP payment mode, and provides a reference for further promoting the reform of the payment mode of TCM dominant diseases. Methods: The Apriori algorithm is used to conduct association mining on the data of inpatients with TCM dominant diseases. Results: Many indicators are strongly related to the actual score cost, balance and burden of the insured. The correlation between disease classification, laboratory fees, examination fees, drug fees, total costs and actual score costs is strong. There is a strong correlation between disease classification, burden of the insured, laboratory fee, examination fee, drug fee, total cost and balance. There is a strong correlation between the medical insurance type of patient, laboratory fees, drug costs and the burden of the insured. Conclusion: The combination of DIP payment and TCM dominant diseases is good, which is in line with the interests of the hospital, medical insurance and patients, however, there is also a large gap in patients’ satisfaction with different types of medical insurance.
关键词
中医优势病种 /
住院费用 /
Apriori算法 /
数据挖掘 /
按病种分值付费
Key words
TCM dominant diseases /
hospitalization expense /
Apriori algorithm /
data mining /
Diagnosis-Intervention Packet
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参考文献
[1] 广东省医疗保障局,深圳市医疗保障局.深圳医保支付政策支持中医优势病种发展促进中医药守正创新[EB/OL].(2021-04-09)[2023-03-02].http://hsa.gd.gov.cn/gab/gddt/content/post_3514712.html.
[2] 广东省医疗保障局.关于开展医保支付改革促进中医药传承创新发展的指导意见:粤医保发〔2021〕43号[A/OL].(2021-10-11)[2023-03-02].http://hsa.gd.gov.cn/gkmlpt/content/3/3559/post_3559792.html#445.
[3] 国务院办公厅."十四五"中医药发展规划[J].江苏中医药,2022,54(5):1-9.
[4] 沈建武,王彬,林生,等.中医药临床优势病种——良性前列腺增生[J].中国实验方剂学杂志,2022,28(2):220-226.
[5] 季聪华,郭清.基于循证医学的中医优势病种评价标准思考[J].中华中医药杂志,2022,37(1):277-280.
[6] 林奕,王学谦,赵晖,等.中医优势病种评价的方法学探讨[J].中医杂志,2021,62(19):1663-1667.
[7] 张明明,亢泽峰.中医眼科优势病种分布及思考[J].中国中医基础医学杂志,2022,28(1):117-119,144.
[8] 张弘,丁科,谢俊明,等.“疗效价值付费”下的中医优势病种DRG付费方案探索[J].卫生经济研究,2021,38(12):75-76,79.
[9] 黄成凤,申丽君,杨燕绥.价值导向型医保付费政策效果探讨——基于柳州市中医优势病种的实证分析[J].卫生经济研究,2022,39(5):37-41.
[10] 崔妍,包志强.关联规则挖掘综述[J].计算机应用研究,2016,33(2):330-334.
[11] 朱奎兵,刘彦戎.一种优化的Apriori关联规则算法[J].信息技术,2022(5):77-81,87.
[12] 郭慧敏,杜军,黄路非.基于R的Apriori算法在高额住院费用中的应用研究[J].中国卫生统计,2017,34(2):315-317.
[13] 罗淳. 关于人口年龄组的重新划分及其蕴意[J].人口研究,2017,41(5):16-25.
[14] 杨业春,李美坤,林圻,等.“按病种分值付费”控费效果研究[J].卫生经济研究,2021,38(6):36-39.
[15] 郭丹丹,苏宇,彭凯,等.“循证+价值”驱动下的中医药医保支付制度创新[J].中国卫生经济,2016,35(8):33-34.
[16] 贾晓倩,王珩,蒋心梅,等.医保支付方式按病种分值付费研究进展[J].中国医院,2022,26(9):18-21.
[17] 于洗河,顾文涛,万龙涛,等.吉林省县级公立医院患者医保报销比例满意状况调查[J].医学与社会,2018,31(3):72-75.
[18] 黄毅,朱怡.广东经验对按病种分值付费国家试点城市的启示和思考[J].华西医学,2021,36(12):1739-1743.
[19] 孙怀平,朱成飞.基于公平理论的人力资源管理政策[J].现代管理科学,2007(1):81-83.
基金
广东省哲学社会科学规划项目2022年度常规项目（GD22CYJ27）
