Research on Medical Insurance Payment Methods Based on Clinical Assessment Tools&#x02014;&#x02014;Taking Sepsis as an Example

doi:10.19546/j.issn.1674-3830.2023.10.006

China Health Insurance ›› 2023, Vol. 0 ›› Issue (10) : 42-47. DOI: 10.19546/j.issn.1674-3830.2023.10.006

Research on Medical Insurance Payment Methods Based on Clinical Assessment Tools——Taking Sepsis as an Example

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Abstract

Objective: The paper proposes a payment method based on the severity of patients' conditions to further improve the scientificity and accuracy of DRG/DIP payment for severe internal diseases. Methods: Taking sepsis as an example, appropriate clinical evaluation tools (Sequential Organ Failure Assessment Score, SOFA Score) were selected to analyze the influencing factors of medical expenses based on the development of disease and the internal logic of clinical resource consumption. Stepwise multiple linear regression analysis was used for the regression analysis and construction of payment model. Results: The SOFA score is significantly correlated with medical expenses, with a correlation coefficient of 0.786 (p<0.001). The linear regression model fits well, and the R2 of univariate is 0.615 and the R² of bivariate is 0.732. Conclusion: Using SOFA score for the medical insurance payment of sepsis is feasible, which can better fit clinical needs and reflect medical value.

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SOFA score / sepsis / regression analysis / medical insurance payment / cost

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Research on Medical Insurance Payment Methods Based on Clinical Assessment Tools——Taking Sepsis as an Example[J]. China Health Insurance. 2023, 0(10): 42-47 https://doi.org/10.19546/j.issn.1674-3830.2023.10.006

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