基于疾病诊断相关组法制定单病种住院费用标准的研究

摘要

目的:基于疾病诊断相关组法(DRGs)制定单病种住院患者的费用标准,为推行按病种付费改革提供定价参考.方法:筛选2009-2013年共42 217份肺癌住院患者的病历资料,采用非参数检验法对住院费用的影响因素进行分析,利用决策树模型进行DRGs分类,并计算标准费用和超线费用.结果:是否手术、是否首次住院、是否医保这3个变量被纳入分组规则,共形成7个DRGs组合,计算得出的标准总费用对实际付费总额的解释效果达到77.87％,10.76％的线外病例消耗掉了32.31％的医疗资源.结论:制定更合理的费用支付标准及逐步建立疾病诊断相关组法的结算方式是控制医疗费用的重要途径.%Objective:To design the standard for inpatients' expenses with single disease based on diagnosis related groups(DRGs) to provide references for pricing the DRGs reform.Methods:A total of 42 217 medical records from 2009 to 2013 were extracted and analyzed with nonparameter test.The decision tree model were used for DRGs.The standard expenses and ultra line expenses were calculated.Results:The variables such as whether take the operation,whether admitted for the first time and whether under medical insurance were included in the group rules and classified the inpatients into 7 groups for DRGs.The results showed that the standard expenses calculated reached to 77.87％ of the actual expenses.10.76％ of the cases outside the lines consumed 32.31％ of the medical resources.Conclusion:It suggested to develop more reasonable payment standard and gradually establish payment on DRGs for controlling medical expenses.