目的: 冠状动脉血流储备分数（Fractional Flow Reserve, FFR）在临床应用中还处于普及发展阶段。本研究旨在探讨含FFR操作的医保住院病例在广州市2018版及2022版DIP政策下,病种分值及医保标准支付对比,探讨FFR操作相关病种的医保支付效益,提出病种分组优化建议。方法: 采用对比分析法,分析比较含FFR操作住院数据在不同版本DIP病种目录的入组差异、标准分值及医保结余差异;采用独立样本t检验,验证不同版本DIP政策下的例均医保标准支付费用是否存在显著差异;采用函数统计法,汇总分析近三年含FFR操作入组病种亏损数据的总值、均值等。结果: 相较于2018版DIP病种分值库,2022版DIP病种分值库中含FFR操作的病种数量增加、标准分值支付提高,支付更加充分,医院端亏损减少明显。结论: DIP病种分值库有待更进一步优化;2022版DIP病种库对含FFR操作的病种支付更加充分;含FFR操作的病种组合可通过将手术操作码申请为扩展码或者新增病种组合的方式进行调整,以适应临床实际需求。

Objective: The application ofin clinical practice is in the stage of popularization, development. The purpose of this study was to explore the comparison of disease category score, medical insurance standard payment of medical insurance inpatients with FFR operation under the DIP policy of Guangzhou2018edition, 2022edition, explore the benefits of medical insurance payment for FFR operation-related diseases, put forward suggestions for disease grouping optimization. Methods: Comparative analysis method was used to analyze, compare the differences in enrollment, standard scores, medical insurance balance of hospitalization data with FFR operation in different versions of DIP disease catalogs. Independent sample T test was used to verify whether there were significant differences in the average medical insurance standard payment under different versions of DIP policies. Using the function statistics method, the total value, average value of the loss data of the diseases with FFR operation in recent three years were summarized, analyzed. Results: Compared with the DIP disease score database of2018edition, the number of diseases with FFR operation in the DIP disease score database of2022edition increased, the standard score payment increased, the payment was more adequate, the loss at the hospital side decreased significantly. Conclusion: DIP disease score database needs further optimization. The2022version of DIP disease database pays more adequate for diseases with FFR operation. The case mix of diseases with FFR operation can be adjusted by applying the operation code as an extended code or a new case mix of diseases to meet the actual clinical needs