| Research background and purposeDiagnosis Related Group(DRG)is a discharged cases grouping system based on principles of the clinical process similarity and the consistency and resource consumption,as well as a set of medical management tools essentially,of which the scientific nature embodied in the process of grouping,on the basis of the patient’s primary diagnosis,combination of patients factors such as treatment method,age,outcome,complication etc.,and the patient cases eventually will be divided into corresponding DRG cases group.There is a wide range of applications on DRG.Since the 1980s,DRG has began to be studied in China,of which the application has been developed from medical quality management and performance management to cost management and medical insurance payment and other fields,achieving phased results.In recent years,with the rapid development of social economy,the continuous improvement of residents’ living standards and the increasing demands for health care,medical insurance funds all over the country are in urgent need,so the reform the payment method of medical insurance has become essential.The act named the Opinions of the CPC Central Committee and the State Council on Deepening the Reform of the Medical Security System issued on February 25,2020,was clearly proposed to "vigorously promoting the application of big data,carrying out a diversified and compound medical insurance payment mode based on payment by disease,and promoting payment by grouping related to disease diagnosis".At present,the disease diagnosis related group reform pilot is widely carried out in many places of the country,and hospitals are facing a revolution of the medical insurance payment mode.Therefore,it is of great theoretical and practical significance to study the influencing factors of DRG payment reform on the inpatient services and costs of hospitals so as to put forward scientific suggestions on promoting the implementation of DRG payment in China,which is also important to manage the unreasonable growth of medical expenses and promote the construction of public hospitals’operating capacity.At present,studies on DRG payment mainly evaluate the implementation effects from resource consumption,performance management and cost impact and etc.In the field of DRG charge control,the previous studies mainly focused on some disease of some hospital,analyzing the effects of the DRG implementation on institution economic operation,are in a small sample size,research on single disease,regional limitations such as faults,which were usually in a small size of disease cases,types as well as area limitation,resulting in lacking in representative studies.So there is no DRG study in large scale of multiple diseases and areas in China.Considering the previous studies,Difference in difference(DID),a research method for effects of economic policies,has been used to compare the traditional medical output indicators to analyze the DRG paying policy effects on overall cost and performance of hospitals as well as related cost and performance of DRG cases,so as to provide political suggestions for further perfecting the reform of DRG paying.Methods1,064,314 patients from 16 provinces including Liaoning,Beijing,Jiangsu,Fujian,Guangdong,Hubei,Shanxi,Guizhou,Yunnan and Guangxi were recruided in this study,covering a total of 376 hospitals in the eastern,central and western regions of the country.Among them,the number of patients in the intervention group was 53521,accounting for 5.03%.The number of cases in the control group was 1010793,accounting for 94.97%.Through the analysis of the historical information of hospitals and discharged patients.and the comprehensive implementations of literature research,statistical description,analysis of variance,differential method,etc.,Results1.Integral operation status of sample hospitals before and after the implementation of DRG paymentThe whole 376 hospitals distributed in 16 provinces of the country are all tertiary hospitals in this study,in which Guangdong and Beijing accounted for 20.21%and 14.63%,respectively.(1)Changes of human resources in hosipitalsThere were significant increases in the indicators such as the numbers of health technicians,practicing physicians and clinical practitioners between before and after the implementation of DRG payment(P<0.05).(2)Changes in the number of beds in hospitalsCompared with before the implementation of DRG payment,the actual number of beds and the actual total number of open bed days in hospitals increased significantly after the implementation of DRG payment(P<0.05).(3)Changes in service of hospitalsThere were significant increases in the indicators such as the numbers of inpatients and the inpatient operation between before and after the implementation of DRG payment(P<0.05).(4)Incomes of hospitalsThere were significant increases in the total income of hospitals,medical income,income from emergency and outpatient,incomes of outpatient health materials,Chinese patent medicine and cut crude drug,hospitalization,inpatient examination,inpatient laboratory exatmination,inpatient operation and hospitalization health material as well as other indicators between before and after the implementation of DRG payment(P<0.05).2.Effects of DRG payment implementation on inpatient services and costsThe recruided cases were analyzed in terms of sample region,year distribution,age,insurance type,etc.The cases came from all the 26 Major Diagnostic Categories(MDC).There were significantly differences in the fields of insurance types,treatment methods through the double-difference method(P<0.05).(1)Overall,in terms of the average effects,the implementation of DRG reduced the total cost of patients by 3.05%,the medical cost by 5.13%,the drug cost by 5.13%and the average hospital days by 4.08%,while increased the out-of-pocket cost by 28.11%.Totally,the implementation of DRG had no significant effects on the cost of in-hospital examination or consumables,so as to antibiotic administration,readmission rate within 31 days or surgery operation.(2)In terms of different insurance types,from the perspective of average effects,the implementation of DRG reduces the total cost of urban medical insurance patients by 3.92%,increases the out-of-pocket cost by 69.89%,reduces the medical cost by 8.61%,reduces the drug cost by 4.88%,and increases the examination cost by 5.13%,the average hospital days decreased by 3.92%;The total cost of resident medical insurance patients decreased by 6.76%,the drug cost decreased by 13.93%,the average hospital days decreased by 4.88%,and the probability of antibiotic use increased by 5.13%.The out-of-pocket cost of NRCMS patients decreased by 21.34%,the medical cost increased by 4.08%,the examination cost decreased by 5.82%,the average hospital days decreased by 2.96%,the probability of antibiotic use decreased by 3.92%,and the probability of 31-day readhospital increased by 2.02%,the probability of surgery increased by 2.02%.In general,the implementation of DRG has a significant difference in hospitalization costs for patients with different insurance policies.(3)In terms of the average effects of different treatment methods,the average hospitalization days of surgical patients decreased by 5.45%.The cost of consumables for non-operating room patients increased by 45.60%,and the probability of readmission rate within 31 days decreased by 3.14%.There was no significant difference in the indicators of internal medicine patients.In general,the implementation of DRG had no significant effects on hospitalization costs of patients with different treatment methods.3.Effects of DRG payment implementation on inpatient services and costs of patients with different Major Diagnostic Categories.A retrospective analysis of medical data from all the patients of 26 Major Diagnostic Categories showed that the implementation of DRG payment had different effects on different MDC groups.In terms of total hospitalization costs,there were significant decreases in 7 MDC groups.In terms of out of pocket expenses,there were significant increases in 6 MDC groups.In terms of medical expenses,there were significant decreases in 6 MDC groups.In terms of medicine expenses,there were significant decreases in 7 MDC groups.In terms of examination expenses,there were significant increases in 4 MDC groups.In terms of medical consumable material expenses,there were significant decreases in 2 MDC groups as well as significant increases in 2 MDC groups.In terms of average hospitalization time,there were decreases in 7 MDC groups while an increase in myeloproliferative diseases and functional disorders group.And there were no significant difference in the other MDC groups.In terms of antibiotic use,there were decreases in 5 MDC groups and increases in 2 MDC groups,which were respiratory disease and functional disorders group and muscle,bone disease and functional disorders group,respectively.In terms of readmission rate within 31 days,there was a decrease in myelodysplastic diseases and functional disorders,poorly differentiated tumor group while an increase in the neurological disorder and functional disorders group,there were no difference in the other MDC groups.In terms of operation rate,there were increases in 4 MDC groups while an decrease in diseases and dysfunction of female reproductive system group,there were no difference in the other MDC groups.Research conclusionIn this study,26 MDC were analyzed and studied creatively based on the MDC mode,covering a wide range of cases and highly representative.The related conclusions are as follows:1.In this study,there were significant increases in most indicators such as human resources,number of beds,services,incomes and the service capacity of the sample hospitals,especially the number of practicing physicians and clinical diagnosis and treatment operations after the implementation of DRG payment.From the view of medical service performance management,the application effect of DRG payment increased significantly the growth rate of inpatient service,the income index of some outpatients and the financial income level of sample hospitals.2.In general,the implementation of DRG payment had no significant influence on the cost of inpatient examination,the cost of consumables,the antibiotic use,the readmission rate within 31 days,and the operation.3.Considering the major types of diseases,there are different effects on medical services and hospitalization costs for inpatients in different disease groups between before and after the implementation of DRG payment.In this article,the different changes of multiple disease costs before and after the DRG payment were studied to form a set of feasible implementation plan for promoting the DRG payment,providing scientific basis and reference for the next step of DRG policy impliment,evaluating the implementation effects of different DRG versions. |
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