目的: 在按疾病诊断相关分组（Diagnosis Related Groups, DRG）付费背景下,比较人工关节集中带量采购（以下简称“集采”）实施前后髋关节、膝关节置换手术患者住院医疗费用结构变化,为评估人工关节集采效果提供参考。方法: 以2021—2023年某院“IC29 髋、肩、膝、肘和踝关节置换术”DRG病组下的髋关节、膝关节置换手术患者为研究对象,采集患者基本信息、住院信息、医疗费用信息等,区分集采前后两个主要阶段,采用描述性统计分析、卡方检验、非参数检验以及结构变动度等方法分析医疗费用变化。结果: 集采后患者住院天数显著下降（P<0.05）,集采对患者住院总费用、医疗服务费用、药品费用、耗材费用产生显著影响（P<0.05）,其中位数下降值分别为25261.12元、1069.04元、849.24元、8299.53元,耗材费用、医疗服务费用、检验费用结构变动贡献率分别为50.00%、28.37%、12.13%,集采后医保基金支付金额、个人支付金额中位数分别下降2283.98元、12729.65元,DRG支付金额中位数增加1274.45元。结论: 在人工关节集采与DRG付费多重影响下,髋关节、膝关节置换手术患者住院费用结构明显优化,患者住院医疗负担减轻,医保基金使用更加高效。

Objective: Under the background of DRG payment, the paper compares the hospitalization cost structure changes of hip and knee joint replacement patients before and after the implementation of centralized procurement policy, to provide references for evaluating the effectiveness of artificial joint centralized procurement. Methods: Hip and knee joint replacement surgery patients under the DRG group of IC29 were included as samples. The patients' basic information, hospitalization information, and medical cost data were collected, distinguishing the two stages before and after the centralized procurement. The descriptive statistical analysis, chi-square test, Mann-Whitney U test, and degree of structure variation analysis were employed. Results: Patient's hospitalization days significantly decreased after centralized procurement policy (P<0.05). Centralized procurement had significant impacts on patients' total hospitalization costs, medical service costs, drug costs, and consumable costs (P<0.05), and the corresponding median values decreased by 25261.12 yuan, 1069.04 yuan, 849.24 yuan, and 8299.53 yuan, respectively. The contribution rate of the structural changes of the consumables costs, medical services costs, and inspection costs was 50.00%, 28.37%, and 12.13%, respectively. The median value paid by the medical insurance fund and individuals decreased by 2283.98 yuan and 12729.65 yuan, while the median value of DRG payment increased by 1274.45 yuan. Conclusion: Under the centralized procurement of artificial joint and DRG payment, the structure of hospitalization cost of hip and knee joint replacement surgery patients is optimized, the inpatient medical burden of patients is reduced, and the medical insurance fund is used more efficiently.