目的: 探索CHS-DRG付费改革对肿瘤专科医院服务效率和住院费用的影响。方法: 对江苏省某肿瘤专科医院2020年6月至2023年9月的医疗运行数据进行整理,采用间断时间序列分析对月度服务效率和住院费用相关指标的变化趋势进行统计分析。结果: 与改革前相比,平均住院日无明显变化,但手术人数保持增长趋势,出院人数则在改革瞬时下降（P<0.01）,改革后保持稳定。住院费用在改革瞬时（P<0.01）和改革后（P<0.05）均出现下降,自费费用由上升趋势变为显著下降趋势（P<0.01）。在住院费用明细中,西药费继续保持显著下降趋势（P<0.01）;耗材费、手术费和治疗费则由下降趋势转为上升趋势（P<0.05）;检查费在改革瞬时出现显著上升（P<0.01）,但治疗费在改革瞬时出现显著下降（P<0.01）,且都在改革后保持上升趋势。结论: CHS-DRG付费改革对肿瘤专科医院服务效率有一定改善,对促进医院控制住院费用过快增长效果显著,住院费用和自费费用下降明显,住院费用结构得到优化,但仍有改进空间。
Abstract
Objective: The paper explores the impact of China Healthcare Security Diagnosis Related Groups (CHS-DRG) payment reform on the service efficiency and inpatient costs in cancer hospital. Methods: The medical data of a certain cancer hospital in Jiangsu Province from June 2020 to September 2023 was organized. The monthly service efficiency and inpatient costs were analyzed statistically by interrupted time series analysis (ITSA). Results: Compared with before the reform, the average length of stay did not change significantly but the number of surgical patients maintained an increasing trend. The number of discharged patients decreased instantaneously (P<0.01), and remained stable after the reform. The inpatient cost decreased both at the moment of reform (P<0.01) and after the reform (P<0.05), while the out-of-pocket cost changed from an increase to a significant decrease trend (P<0.01). In terms of the composition of inpatient costs, western medicine cost continued to maintain a significant downward trend (P<0.01), the costs of consumables, operation and treatment turned from a downward trend to an upward trend (P<0.05). The examination cost increased significantly at the moment of reform (P<0.01), but the treatment cost decreased significantly in the instant of reform (P<0.01), and both maintained an upward trend after the reform. Conclusion: The implementation of CHS-DRG payment reform has improved the service efficiency of cancer hospital. The control effect of inpatient cost is remarkable, and the inpatient cost and out-of-pocket cost decrease obviously. The inpatient cost structure has been optimizing, but there still are shortcomings that need further improvement.
关键词
疾病诊断相关分组 /
间断时间序列 /
服务效率 /
住院费用
Key words
CHS-DRG /
interrupted time series analysis /
service efficiency /
inpatient cost
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