山东大学学报 (医学版) ›› 2025, Vol. 63 ›› Issue (10): 98-106.doi: 10.6040/j.issn.1671-7554.0.2025.0509
• 公共卫生与预防医学 • 上一篇
齐宝华1,岳彩宾2,岳毅3,田磊4,陈孔德4,王璐颖4,刘昱同4,邹巧4
QI Baohua1, YUE Caibin2, YUE Yi3, TIAN Lei4, CHEN Kongde4, WANG Luying4, LIU Yutong4, ZOU Qiao4
摘要： 目的 分析国家医疗保障疾病诊断相关分组(China healthcare security diagnosis related groups, CHS-DRG)付费下青岛市试点医院患者住院天数及费用,为医疗机构住院天数和费用合理管控的效果评价提供参考。 方法 收集2021年青岛市17家CHS-DRG付费试点医院803 331例患者的病案首页数据,采用倾向性评分匹配控制混杂因素,通过分析CHS-DRG付费实施前后总体患者层面及核心疾病诊断相关组(adjacent diagnosis related groups, ADRG)层面患者住院天数、住院费用的变化评价CHS-DRG付费实施效果。 结果 倾向性评分匹配后,总体层面CHS-DRG付费实施前后患者的住院天数差异无统计学意义(P=0.112),实施后患者的住院费用中位数显著低于实施前(7 063.79元vs.7 107.14元,降幅0.61%,P<0.001)。患者的自付费用中位数下降更为明显(1 933.46元vs.2 153.84元,降幅10.23%,P<0.001);ADRG组中,呼吸系统感染/炎症组在CHS-DRG付费实施后患者的住院天数、住院费用中位数均低于实施前(P<0.05)。 结论 CHS-DRG 付费在青岛市试点初期可显著降低患者住院费用及自付费用。对住院天数的缩短有一定作用,但总体不显著。医院应提升医疗服务效率,优化临床诊疗路径,以促进CHS-DRG付费政策的落实与完善。
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