医疗费用结构与DRG补偿水平相关性研究.pdfVIP

医疗费用结构与DRG补偿水平相关性研究.pdf

RESEARCHREPORT研究报告

医疗费用结构与DRG补偿水平相关性研究

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任雨青李伟丁锦希

【摘要】

目的：分析医疗费用结构与DRG补偿水平之间的相关性，为医疗机构DRG管理提供参考。方法：收集整理A市2023

年所有病组的医疗费用及DRG清算数据。通过系统聚类的方法将病组按费用结构特征进行划分并探究补偿水平的差异；以全体

病组、不同划分标准下的亚组为分析层级，分别研究各类医疗费用占比与补偿水平的相关性。结果：将病组划分为6类以不同费

用为资源消耗主导的病组，其DRG补偿水平分布存在较大差异；耗材和手术费用与补偿水平显著正相关，其余费用则显著负相

关。结论：医疗机构应合理看待不同病组的补偿水平差异；在此基础上，可以考虑利用医疗费用结构与补偿水平的相关性加强

DRG管理。

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【关键词DRG医疗费用结构支付标准

中图分类号R197文献标识码ADOI10.19660/j.issn.1671-0592.2025.10.10

StudyonthecorrelationbetweenmedicalexpensestructureandDRGcompensationlevel/RENYuqing,LIWei,

DINGJinxi//ChineseHospitals.-2025,29(10):45-48

【Abstract】

Objective:ToanalyzethecorrelationbetweenmedicalexpensestructureandDRGcompensationlevel,providingreference

forDRGmanagementinmedicalinstitutions.Methods:MedicalexpenseandDRGsettlementdataofalldiagnosis-relatedgroups(DRG)

incityAin2023werecollected.Byapplyingsystematicclustering,DRGwerecategorizedaccordingtoexpensestructurecharacteristics,

anddifferencesincompensationlevelswereexplored.AtthelevelofallDRGandsubgroupsunderdifferentclassificationcriteria,the

correlationsbetweentheproportionofdifferenttypesofmedicalexpensesandcompensationlevelswereanalyzed.Results:DRGwere

dividedintosixcategoriesdominatedbydifferentexpensetypes,withsignificantdifferencesincompensationlevelsacrosscategories.

Consumableandsurgicalexpensesweresignificantlypositivelycorrelatedwithcompensationlevels,whileotherexpenseswere

significantlynegativelycorrelated.Conclusion:Medicalinstitutionsshouldreasonablyrecognizedifferencesincompensationlevelsacross