目的: 通过分析医院结余水平影响因素,为DIP支付方式下医疗费用管理、病种成本管理和医保管理等提供理论依据和决策建议。方法: 基于广东省某三甲医院2022年DIP实际付费病例数据,采用组间均值比较和多元线性回归模型分析医院可控结余的影响因素。结果: 医院可控结余与病例的费用消耗指数、时间消耗指数呈显著负相关关系;低年龄段病例、基层病种病例、费用偏高病例、二级手术治疗病例的可控结余相对较低,三级手术治疗病例、RW值较高病例的可控结余相对较高。结论: DIP付费下,医疗机构应明确战略定位,合理分配医疗资源,重视运营管理,优化收入结构;建议医保部门持续完善DIP付费机制,提高病种分值费用和医疗资源消耗的匹配程度。

Objective: The paper analyzes influencing factors of hospital balances under DIP Policy, as to provide theoretical basis and decision-making suggestions for management of medical expenses, cost management of disease groups and health insurance management. Methods: Based on 2022 DIP health insurance payment of cases in a tertiary hospital in Guangdong Province, the paper analyzes factors influencing clinical controllable balances with mean comparison between groups and multiple linear regression. Results: Significant negative correlation was observed between hospital controllable balances and time consumption index as well as cost consumption index of cases. Balances are relatively lower in cases of lower age, of local disease groups, with high positive cost deviation and with level 2 surgery. Balances are relatively higher in cases with level 3 surgery and higher relative weight. Conclusion: Under DIP policy, greater attention should be paid to strategy positioning, resources allocation, operation management and revenue structure. Mechanism of DIP policy needs to be improved continuously to enhance matching between DIP payment and medical resources consumption.