Objective: The paper explores the management methods for extremely high-cost cases by analyzing the characteristics of such cases during the 3-year implementation of DRG payment in a tertiary hospital in Wuhan City. Methods: This study focused on the extremely high-cost cases among the DRG cases from January 2021 to December 2023 in a tertiary hospital in Wuhan City. A descriptive analysis was conducted to investigate the basic characteristics and cost structure of these cases. Results: A total of 1585 cases (2.40%) with extremely high costs were identified in the sample hospital during the 3-year period. The age of these patients was 64.00 years (51.00, 74.00), and the length of hospital stay was 15.06 days (10.00, 24.66). The DRG weight was 0.59 (0.30, 0.93). The median total hospitalization cost for all patients was 27116.08 yuan. The three individual cost categories that accounted for more than 10% of the total cost were medication costs (22.85%), laboratory test costs (17.94%), and treatment costs (10.32%). The top three MDC with the most cases were MDCB, MDCE, and MDCC. The top three ADRG were BR2, ES2, and CX1. The top three DRG were BR25, ES25, and ES23. Conclusion: The incidence of extremely high-cost cases in the sample hospital is relatively stable, and they are mainly non-difficult and severe disease groups. Although the average hospitalization cost per patient has changed slightly, the key six individual costs have continued to change. Measures such as implementing disease classification management, standardizing clinical pathways, conducting DRG data analysis, and accelerating information construction can be taken to manage the extremely high costs cases.
Key words
DRG /
extremely high-cost cases /
cost structure /
distribution of disease
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] 陆烨,余彦涛.某三甲医院264例肾移植病例DRG费用研究[J].中国农村卫生, 2021,13(17):76-77.
[2] 黄离团. DRG付费方式下医院成本管控探讨[J].行政事业资产与财务,2021,(19):56-57.
[3] 杨松,吴婧文,余丽君,等.DRG高倍率病例现状与政策优化思考[J].卫生经济研究,2022,39(04):24-27+32.
[4] 刘玥,赵凯,魏明丽.DRG支付下公立医院精细化成本管控的实证研究[J].卫生经济研究, 2022,39(03):83-87.
[5] 周道亮. DRG支付方式改革下的病组拨付差额分析[J].现代医院,2023,23(08):1234-1236.
[6] 文娟,张翔,卞静.DRG付费下高倍率病例解决路径分析[J].中国卫生产业,2023,20(1):157-160.
[7] 任旭,丁锦希,李佳明,等.DRG亏损病组的精细化管理研究[J].中国医疗保险,2023,(06):53-59.
[8] 王冲,齐佳.DRG付费下专科医疗机构结算管理的探索与思考——以哈尔滨市DRG付费试点为例[J].中国医疗保险,2022,(01):61-65.
[9] 李洋,崔立君,毛静馥,等.基于DRG付费改革的医院病组盈亏结构分析[J].中国卫生经济,2022,41(09):81-83.
[10] 王文君,贾晓倩,周道平,等.DRG高倍率病例与正常倍率病例差异及住院费用灰色关联分析[J].中国医院,2023,27(05):55-58.
[11] 梁沛枫,赵媛,杨飞,等.高倍率病例住院费用灰色关联及影响因素回归分析[J].中华医院管理杂志,2020,36(06):496-499.
[12] 李秀梅,刘理,胡海源,等.DRG支付下脑卒中患者住院费用控制研究[J].卫生经济研究,2022,39(01):44-47.
[13] 李彤宇,李星,王强.DRG支付下公立医院成本运营及效益提升路径研究[J].卫生经济研究, 2023,40(07):79-81+85.
[14] 李江峰,刘淑红,周传利,等.基于DRG病种分类的医院科室运营方案设计与应用[J].中国医院管理,2023,43(11):20-23.
[15] 贾爱华. DRG支付下对临床科室病种结构优化措施分析[J].发展改革理论与实践,2022,9(5):163-165.
[16] 贾晓倩,王珩,蒋心梅,等.医保DRG付费改革下某三甲医院分级诊疗下沉病组路径初探与思考[J].中国医院,2022,26(09):6-9.
[17] 张钰婉,卢亚娟,谈在祥,等.DRG结付下住院费用超支原因及管控建议——基于模糊集定性比较分析法[J].卫生经济研究,2023,40(04):80-83.
[18] 徐学萍. 基于疾病诊断相关分组(DRG)原则的住院费用研究[D].济南:山东大学,2020.
[19] 罗富健,倪冬梅,范磊,等.DRGs付费模式下2型糖尿病患者住院费用的影响因素分析[J].中国病案,2023,24(09):60-63.
[20] 郭腾飞,郑慧玲,余启萍,等.宜昌市某医院甲状腺癌手术患者住院费用灰色关联分析[J].医学与社会,2022,35(02):90-94.
[21] 韩冬青.公立医院实施DRG支付的问题及路径改善研究[J].卫生经济研究,2023,40(05):83-85+89.
[22] 刘岩,魏岚,李天舒,等.基于DRGs付费模式下成本管理新需求的医院信息系统改进研究[J].中国数字医学,2021,16(02):85-88.
[23] 许椿榕. 基于DRG+大数据的医院精细化运营管理研究[J].中国管理信息化,2022,25(20):213-216.
[24] 于洪满. 医保智能化监管和控费审核模式的应用思路[J].卫生经济研究,2016(02):18-19.
[25] 任毅,李风芹,于蔚,等.DRG支付方式下医院成本管理特征、路径选择与策略[J].中国卫生经济,2020,39(09):84-87.
[26] 崔斌,程斌,朱兆芳,等.DRG付费模式下的医保基金监管指标体系构建[J].中国卫生经济,2022,41(09):29-32.
