| 摘要: |
| 目的:探讨疾病诊断相关分组(DRG) 正式付费政策实施前后某三甲儿童医院呼吸系统其他手术不伴合并症或并发症
(EJ15 病组)患者的住院费用变化情况,为儿童医院落实医保支付方式改革提供参考。方法:比较分析DRG 正式付费政策实施
前(2023 年1-5 月)和实施后(2024 年1-5 月) 该院入EJ15 病组患者的总住院费用、费用构成、平均住院时间等情况。结果:
DRG 正式付费政策实施后,EJ15 病组患者的平均总住院费用减少596. 40 元,平均医保统筹基金支付费用减少321. 17 元,平均
个人自付费用减少399. 13 元。费用构成方面,药品费用中位数减少290. 74 元,药占比下降3. 11 个百分点;耗材费用中位数减
少20. 33 元,耗占比下降0. 47 个百分点。结论:DRG 支付方式改革可合理控制儿童常见多发疾病的医疗费用增长,减少医保基
金支出,减轻患者经济负担,回归医务人员医疗技术服务价值,达到多方共赢的目的。 |
| 关键词: 疾病诊断相关分组 儿童 医保 合理用药 经济负担 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2025.08.001 |
|
| 基金项目:基金项目:国家儿童健康与疾病临床医学研究中心-重庆市儿童医疗保障创新研究示范基地项目,编号NCRCCHD-2019-HP-16。 |
|
| Evaluation of Diagnosis Related Groups Payment Reform Based on EJ15 Disease Group in a Grade Ⅲ,Level A Children’s Hospital |
| Ran Rong, Wang Junjun, Tang Chengjie, Tan Siran, Li Wei |
| (Children’ s Hospital of Chongqing Medical University,
Chongqing 401122, China) |
| Abstract: |
| Objective: To probe into the changes of hospitalization costs of patients with other respiratory surgery without comorbidities
or complications (EJ15 disease group) in a Grade Ⅲ, Level A Children’s Hospital before and after the implementation of the formal
payment policy of diagnosis related groups (DRG), so as to provide references for children’s hospital to implement the reform of medical
insurance payment. Methods: Changes in the total hospitalization costs, cost structure, average hospitalization day and other data of
EJ15 disease group in the hospital before (from Jan. to May 2023) and after (from Jan. to May 2024) the implementation of formal
payment policy of DRG were compared and analyzed. Results: After implementation of formal payment policy of DRG, the average total
hospitalization costs of patients in EJ15 disease group decreased by 596. 40 RMB, the average medical insurance pooling fund decreased
by 321. 17 RMB, and the average individual out of pocket expenses decreased by 399. 13 RMB. In terms of cost structure, the median
cost of drugs decreased by 290. 74 RMB, and the proportion of drugs decreased by 3. 11 percentage points. The median cost of
consumables decreased by 20. 33 RMB, and the consumption proportion decreased by 0. 47 percentage points. Conclusion: The reform
of DRG payment can reasonably control the growth of medical costs for common and multiple diseases in children, reduce medical
insurance fund expenditures, reduce the economic burden of patients, better recognize the value of medical professionals’ expertise,
creating mutual benefits across the board. |
| Key words: diagnosis related groups children medical insurance rational drug use economic burden |
