目的: 探索DRG付费改革对脑卒中康复病例住院费用的影响。方法: 对比分析广西壮族自治区南宁市某专科医院DRG付费改革前（2019年—2020年）、改革后（2021年—2022年）脑卒中康复病例的一般情况、住院天数、住院费用、住院费用构成等,探讨DRG付费改革对脑卒中康复病例住院费用的影响。结果: 实施DRG付费改革后,该院脑卒中康复病例的住院天数由28天下降至21天（Z=-18.569,P<0.001）,住院费用中位数由25303.44元下降至22512.44元（Z=- 9.616,P<0.001）,差异有统计学意义。住院费用中,各子类费用均有不同程度的下降,康复类、诊断治疗类、综合服务类住院费用占比上升,药品类、耗材类住院费用占比下降。结论: DRG付费降低了脑卒中康复病例的住院费用,缩短了住院时间,但不适用于脑卒中康复病例。建议医保管理部门积极调研康复病例的需求,并结合当地实际探索应用康复病例床日付费、床日点数付费,医疗机构提高康复治疗的同质性,保障康复患者的有效治疗和医保基金的合理使用。
Abstract
Objective: The paper explores the impact of DRG payment reform on the hospitalization costs of cerebral stroke rehabilitation cases. Method: The influence of DRG payment reform on the hospitalization cost of cerebral stroke rehabilitation cases was discussed by comparing and analyzing the general situation, hospitalization days, hospitalization cost and composition of hospitalization cost of cerebral stroke rehabilitation cases in a specialized hospital in Nanning, Guangxi Zhuang Autonomous Region before and after the reform. Result: The results showed that after the implementation of DRG payment reform, the hospitalization days of cerebral stroke rehabilitation patients decreased from 28 days to 21 days (Z=-18.569, P<0.001). The median hospitalization costs of cerebral stroke rehabilitation decreased from 25303.44 yuan to 22512.44 yuan after implementation (Z=-9.616, P<0.001), and the difference is statistically significant. The decrease in the subcategories of hospitalization costs was also observed. The proportion of hospitalization costs for rehabilitation, diagnosis and treatment and comprehensive services increased, while the proportion of hospitalization costs for drugs and consumables decreased. Conclusion: The DRG payment reform will reduce the hospitalization cost and shorten the hospitalization time of cerebral stroke rehabilitation cases, but it is not suitable for cerebral stroke rehabilitation cases. It is recommended that the medical insurance department should actively investigate the needs of rehabilitation cases and explore the application of bed-day payment and bed-day-point payment for rehabilitation cases based on local situations. Medical institutions should improve the homogeneity of rehabilitation treatment, ensure the effective treatment of rehabilitation patients and the reasonable use of medical insurance funds.
关键词
脑卒中康复病例 /
住院费用 /
DRG /
付费方式
Key words
cerebral stroke rehabilitation cases /
hospitalization costs /
DRG /
payment method
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