目的: 以“取除骨折内固定装置”手术为例,探讨多种因素对单病种支付模式下费用超标的影响,为医院提供相关管理策略。方法: 收集广州市某三甲医院数据,采用Logistic模型分析患者费用超标的影响因素。结果: 2019—2023年,单病种支付患者的次均医疗费用从8891.38元降到8080.00元,每年的费用超标率均较高（26.56%—50.88%）。住院天数、手术部位、麻醉方式、手术类型均是增加费用超标风险的因素。结论: 建议医院缩短住院天数、设定手术麻醉清单,以提升精细化管理水平,医保部门可考虑根据手术类型细化支付标准。
Abstract
Objective: Taking the surgery of removing internal fixation device for fracture as an example, the paper explores the influencing factors of overspending under the single disease payment model to provide management strategies for hospitals. Methods: The data were collected from a tertiary hospital in Guangzhou, and the influencing factors of overspending were analyzed by Logistic model. Results: From 2019 to 2023, the average cost per patient decreased from 8891.38 yuan to 8080.00 yuan, but the overspending rate per year was high (26.56%-50.88%). The length of stay, surgical site, type of anesthesia and operation type increased the risk of overspending. Conclusion: Hospitals should shorten the number of days in hospital and make the surgical anesthesia list to improve fine management, and the healthcare security department are supposed to differentiate the payment standards based on the type of surgery.
关键词
单病种支付 /
取除骨折内固定装置 /
费用超标 /
影响因素
Key words
single disease payment model /
removing internal fixation device for fracture /
overspending /
influencing factor
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基金
中山大学孙逸仙纪念医院科研课题资金“按病种分值付费在某三级医院的实施效果与对策研究（GL2205）”
