Objective: Based on the standard of payment by medical item, the differences between DRG and DIP in medicare reimbursement and the standard of payment by medical item were compared to explore the advantages and disadvantages of DRG and DIP reimbursement for ischemic heart disease. Methods: According to the different treatment methods, 1296 patients with ischemic heart disease were divided into non operation group (617), examination group (276) and operation group (403). R, Office Excel and other tools were used to analyze the cost structure of each group and the cost differences among them, and to compare the corresponding DRG and DIP average reimbursement, so as to explore the best current medicare reimbursement approach for ischemic heart disease under DRG and DIP system. Results: (1) There was a significant difference in the cost of ischemic heart disease with different treatment methods. The medical cost of the operation group was significantly higher than that of the examination group, and the medical cost of the examination group was significantly higher than that of the non-operation group. (2) The estimated cost of DRG payments was more similar to the actual cost of cases with fewer operations and fewer costs. The measured cost of the DIP disease score payment was more similar to the actual cost of more intensive and severe cases. Conclusion: DRG payment can cover the cost of ischemic hearts diseases in most cases, but does not cover the cost of high-cost cases and there is a large difference between DRG payment and payment by medical item. Compared with DRG payment, the DIP payment is closer to the actual cost of severe and complex ischemic heart disease cases, but cannot accurately reflect the actual cost of less costly cases. Both DRG and DIP can play a positive role in hospital cost control and reducing patient burden, but DIP is superior to DRG from the perspective of fine management. For cases that cannot be covered, cost control should be strengthened and DRG and DIP grouping refinement rules continue to be discussed.
Key words
ischemic heart disease /
DRG /
cost structure /
DIP
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] Xiaofei Zhang, Arshad A.Khan,Ehtesham UL Haq et.al.Increasing mortality from ischaemic heart disease in China from 2004 to 2010: disproportionate rise in rural areas and elderly subjects. 438 million person-years follow-up[J]. European Heart Journal-Quality of Care and Clinical Outcomes, 2017,3(1):47.
[2] 赵璇,程薇,袁蓓蓓.北京市慢性缺血性心脏病住院患者药品使用及费用研究[J].中国卫生政策研究,2020,13(2):53-60.
[3] 舒琴,李迪,孙扬,等.基于变异系数计算的DRG本土化应用分析及建议[J].中国医院管理,2019,39(8):43-45.
[4] 中国新闻周刊.专访国家医保局:心脏支架集采节省了117亿,下一步将有序推进[EB/OL].https://finance.sina.com.cn/tech/2020-12-14/doc-iiznctke6448404.shtml.
[5] 陈一龙,崔欢欢,辜永红,孙麟.某大型综合医院心房颤动住院费用分析及管控建议[J].中国医疗保险,2021(4):59-62.
[6] 朱培渊,王珊,刘丽华.DRG支付方式改革在公立医院的实施路径讨论[J].中国卫生经济,2018,37(5):32-35.
[7] Nicholas S.Downing1 and Jing Li. Ischaemic heart disease in China:the time to address rising mortality rates. Eur Heart J Qual Care Clin Outcomes 2017;3(1):4-5.
