目的: 射频消融联合经皮左心耳封堵术的一站式治疗已广泛被临床认可。本研究旨在探讨该疗法在病种分值付费政策下的医保支付效益。方法: 运用函数统计方法,分析经皮左心耳封堵术及射频消融术相关的病种入组和分值支付变化情况,对比分布式手术及一站式手术的相关数据,包括例均住院费用、例均结余费用、医保基金统筹支付比例等。此外,采用结构变动度分析法,评估按病种分值付费体系下不同时期实施一站式手术后,影响手术住院费用结构变动的主要因素。结果: 2022版DIP病种目录新增射频消融联合经皮左心耳封堵术一站式手术病种组合提高了医保支付分值,支付更加精准;一站式手术住院例均费用进一步下降,参保人住院负担减轻;通过实行一站式手术,医院预估例均医保结余由负转正,有利于三级医疗机构收治疑难杂症病人。结论: DIP病种目录周期性调整至关必要,有助于推动分级诊疗;新增一站式手术组合有效减轻了参保人住院负担;医疗机构要进一步关注耗占比,提高医疗服务收入占比。

Objective: The one-stop treatment of radiofrequency ablation combined with percutaneous left atrial appendage occlusion has been widely recognized in clinical practice. This study focuses on the medical insurance payment advantages of this treatment under the DIP policy. Methods: Functional statistical method was used to analyze the changes of disease enrollment and payment related to percutaneous left atrial appendage closure and radiofrequency ablation, and relevant data of distributed surgery and one-stop surgery were analyzed, including hospitalization cost per case, balance cost per case, and payment proportion of medical insurance fund. The main factors influencing the change of the cost structure of one-stop operation in different periods were analyzed by using the method of structural change degree analysis. Results: The combination of radiofrequency ablation combined with percutaneous left atrial appendage occlusion in 2022 DIP disease list improved the medical insurance payment score and made the medical insurance payment more accurate. The average cost of one-stop surgery patients was further reduced, and the hospitalization burden of the insured was reduced. The estimated average medical insurance balance of hospitals implementing one-stop surgery began to change from negative to positive, which will encourage tertiary medical institutions to treat patients with difficult and complex diseases. Conclusion: Periodic adjustment of DIP disease list is necessary, which is helpful to promote the graded diagnosis and treatment. The one-stop surgical combination is beneficial to the insured, effectively reducing their burden. Hospitals should pay more attention to the consumption ratio and increase the proportion of medical service fees.