缺血性心脏病DRG与DIP付费模式对比分析.pdfVIP

缺血性心脏病DRG 与DIP付费模式对比分析 【摘要 】 目的：以按项目付费作为参考标准，比较缺血性心脏病入组DRG和入组DIP的医保支付费用差异 及与按项目付费费用之间的差异，探讨缺血性心脏病用DRG和DIP支付方式的优缺点。方法：根据治疗方式不 同，把1296例缺血性心脏病病例分为无手术组（617）、检查组(276）和手术组(403)。采用R、Office Excel等工具分 析各组的费用结构和它们之间的费用差异，比较各组对应的DRG和DIP平均支付费用及与按项目付费费用的 差异，以此探讨基于DRG和DIP制度下缺血性心脏病的现行最佳医保支付途径。结果：（1）不同治疗方式的缺 血性心脏病之间的费用差异显著，手术组的医疗费用明显高于检查组的医疗费用，检查组的医疗费用明显高 于无手术组的医疗费用。（2）通过大数据得出，DRG付费的测算费用与操作较少、成本较少病例的实际费用相 似度更高；DIP病种分值付费的测算费用与操作较多，病情严重病例的实际费用相似度更高。结论：DRG付费 能覆盖大多数缺血性心脏病的费用成本，但无法覆盖成本较高病例的费用成本，且支付费用与按项目付费的 费用差异性大；DIP病种分值付费较DRG付费更接近病情严重、操作复杂的缺血性心脏病疾病病例的实际费 用，但无法准确反映成本较少病例的实际费用；DRG和DIP都能对医院成本管控和减少患者负担起到积极作 用，但从精细化管理的角度上看DIP优于DRG。无法覆盖的病例，应加强成本管控,并继续探讨DRG/DIP分组 细化规则。 【关键词 】 缺血性心脏病；DRG；费用结构；DIP Comparative Analysis of DRG and DIP Payment Management Models for Ischemic Heart Disease　Jiang Wenbo, Liu Li, Liang Haohui, Liao Jun (Shenzhen Second People’s Hospital, Shenzhen, 518035) Objective: Based on the standard of payment by medical item, the diff erences between DRG 【Abstract 】 and DIP in medicare reimbursement and the standard of payment by medical item were compared to explore the advantages and disadvantages of DRG and DIP reimbursement for ischemic heart disease. Methods: According to the diff erent treatment methods, 1296 patients with ischemic heart disease were divided into non operation group (617), examination group (276) and operation group (403). R, Offi ce Excel and other tools were used to analyze the cost structure of each group and the cost diff erences among them, and to compare the corresponding DRG and DIP average reimbursement, so as to explore the best current medicare reimbursement approach for ischemic heart disease under DRG and DIP system. Results: (1) There was a signifi cant diff erence in the cost of ischemic heart disease with diff erent treatment methods. The medical cost of the operation group was signifi cantly higher than that of the examination group, and the med