目的: 探讨DIP付费下肿瘤病种支付中药品辅助目录设置及日间化疗支付的精细化调整方法,以及机构等级系数设置与调整方法,完善科学的分值形成机制与动态调整机制。方法: 选取福建省厦门市所有三级医院2021—2023年住院患者作为样本,对抗肿瘤药物治疗住院医疗费用医保基金支付金额的影响因素进行单因素及多因素分析,分析住院天数与抗肿瘤药物对住院医疗费用医保基金支付金额的影响、住院医疗费用变异系数情况以及不同医疗机构费用差异等。结果: 抗肿瘤药物与住院天数对住院医疗费用医保基金支付金额影响显著。结论: DIP付费下,建议部分肿瘤细分病种设置肿瘤药品辅助目录;对日间化疗测算分值,与非日间化疗进行有效差异化支付,以便更加科学精准;对不同医疗机构实行机构等级系数调整,完善医保精细化管理。

Objective: The paper attempts to explore the drug auxiliary catalog setting and refined adjustment methods of daytime chemotherapy payment, as well as the setting and adjustment methods of institution level coefficient under the DIP payment, to improve the scientific score formation mechanism and dynamic adjustment mechanism. Method: All hospitalized patients from tertiary hospitals in Xiamen City, Fujian Province from 2021 to 2023 were selected as samples. Univariate and multivariate analyses were conducted on the influencing factors of the medical insurance fund payment amount for hospitalization medical expenses of antitumor drug treatment. The effects of hospitalization days and antitumor drugs on the medical insurance fund payment amount for hospitalization medical expenses, the CV of hospitalization medical expenses and the differences in fees among medical institutions. Results: Antitumor drugs and hospitalization days have a significant impact on the medical insurance fund payment amount for hospitalization medical expenses. Conclusion: Under the DIP payment, it is recommended to set an auxiliary catalog of tumor drugs for some tumor diseases, calculate the scores for daytime chemotherapy and differentiate them effectively from non-daytime chemotherapy for more scientific and accurate payment, adjust the institutional level coefficient for different medical institutions and improve the refined management of medical insurance.