医院管理

广州中医优势病种分值付费政策实施效果探析

Analysis on the effect of dominant diseases of traditional Chinese medicine under the DIP payment mode in Guangzhou

:849-854
 
       目的   分析广州市中医优势病种按病种分值付费政策实施效果,以期为完善广州市中医病种付费方式改革提供参考思路。方法   以广州市某三甲中医医院住院患者在政策实施前(n=6 057)及实施后(n=7 208)住院病历为研究样本,对医院次均住院医疗费用、中医综合治疗费占比、平均住院日进行两独立样本非参数检验等描述性统计分析。  政策实施后,住院人次增长19%,患者次均住院医疗费用下降7.02%(P<0.001),中医综合治疗费用占比提升0.8%P>0.05),医疗机构平均住院日缩短0.63 d(P<0.001),入组中医优势病种患者自费率较非入组的低,医疗机构总体病例组合指数下降,中医优势病种结算有盈余。结论  中医优势病种按病种分值付费政策有利于医保-患者-医院三方共赢;但中医优势病种入组率有待提高,建议加大对中医医疗机构的支持与助力;中医综合治疗费用占比提升不显著,建议完善中医治疗项目医疗服务价格动态调整机制;中医优势病种仅局限在住院,建议实现诊疗单元全覆盖。
       Objective  To discuss the correlation analysis of the hospitalization expenses of TCM dominant diseases under the DIP payment mode,and provide a reference for further promoting the reform of the payment mode of TCM dominant diseases in Guangzhou.Methods  The nonparametric test was used to analyze the number of inpatients,the average hospitalization cost,and the proportion of TCM comprehensive treatment on the data of inpatient records before and after the implementation of the TCM dominant diseases policy,the sample sizes were 6 057 and 7 028 respectively.Results  After the implementation of the TCM dominant diseases policy,there was a slight fluctuation in the number of inpatients from 6 057 to 7 208,the average hospitalization cost was decreased by 7.02%(P<0.001),the proportion of TCM comprehensive treatment costs had an increase of 0.8%(P0.05),the average length of hospital stay was shorten by 0.63 days(P<0.001),the self-expense  rate of the patients with the TCM dominant diseases of in the group was lower than that of the patients without the group,the total case mix index value of the hospital decreased,but there was a surplus on the group of TCM dominant diseases settlement.Conclusios  The policy is conducive to the tripartite win-win of medical insurance,patients and hospitals.However,the enrollment rate of TCM dominant diseases need to be improved,which is suggested to increase the support for TCM hospitals.The proportion of TCM comprehensive treatment has not increased significantly,so it is suggested to improve the dynamic adjustment mechanism of medical service price of TCM treatment items.The TCM dominant diseases are only limited to hospitalization,and it is recommended to achieve full coverage of diagnosis and treatment units.
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