| Objectives: Based on research of domestic scholars,this study dug the depth of research,selected 4 kinds of surgical and internal diseases according to different categories,analyzed the hospitalization expenses structure of surgical and internal diseases from 2016 to 2019,and strengthened the consideration of hospital operation level by combining with the relevant policies of quality management of simplified DRG-based hospital payment system,such as clinical pathway,rewards and punishment system,etc.Stereotyped interview data were used to analyze the changes in the structure of hospitalization expenses,in order to control the unreasonable growth of medical expenses,relieve the pressure of medical insurance fund operation,improve the efficiency and quality of medical services,optimize the cost structure,promote the coordinated development of medical insurance and medical services,and provide reference for exploring DRGs payment methods.Methods: According to the implementation of simplified DRG-based hospital payment system in Anhui Province and the availability and integrity of data,a representative county hospital in southern Anhui Province was selected after several meetings.4 representative diseases of surgical and internal diseases were selected for this study,which were comprehensive treatment of pneumonia in pediatrics(hereinafter referred to as "pneumonia in pediatrics"),primary hypertension,ureteral nodules and cholecystitis/gallstone(hereinafter referred to as "cholecystitis").This study was divided into 2 groups for data statistical analysis.Because the new rural cooperative medical system and urban residents basic medical insurance(hereinafter referred to as "urban and rural residents")coverage of diseases and fund compensation ratio are similar,so the groups of insured people are combined for statistics,and another group of statisticians group: the insured population of basic medical insurance for urban workers(hereinafter referred to as "urban workers").The data indicators of 4 diseases from 2016 to 2019 were collected,which were divided into hospital indicators and patient indicators.Results:(1)From 2016 to 2019,the structural change degree of material cost of patients with pneumonia in pediatrics in urban and rural residents was VSV =-7.51%< 0,the contribution rate of structural change was CSV = 44.90%,VSV of the treatment cost = 4.36% > 0,CSV = 26.05%,and the proportion of drug cost continued to be higher,more than 30%.The composition of material cost was in a downward trend and well controlled,and the total contribution rate of material cost and treatment cost during 2016-2019 was 70.95%;(2)The sum of drug fees,inspection fees and laboratory test fees of urban and rural residents with primary hypertension was about70%,of which laboratory test fees account for about 30%.In 2016-2019,VSV of the treatment fees of primary hypertension = 7.64% > 0,CSV = 22.06%,VSV of the drug fees =-10.32% < 0,CSV = 29.78%,VSV of the inspection fees =-6.82% < 0,CSV =19.70%.Fees of primary hypertension has been proved to be effective in cost containment;(3)The drug expenses,surgery anesthesia expenses and laboratory test expenses of ureteral calculi in urban and rural residents accounted for about 20%-30%,respectively.And total of the three expenses was about 70%.In 2016-2019,the VSV of surgery anesthesia expenses = 18.84% > 0,CSV = 37.91%,VSV of inspection expenses =-11.62% < 0,CSV = 23.38%,VSV of laboratory test expenses=-10.34% < 0,CSV = 20.80%,the proportion of drugs was relatively low,but there was an upward trend;(4)The sum of drug expenses and surgery anesthesia expenses for cholecystitis in urban and rural residents was about 60%,and the proportion of surgery anesthesia expenses was relatively high,about 30%.In 2016-2019,VSV of surgery anesthesia expenses = 5.72% > 0,CSV = 26.91%,VSV of inspection expenses =-8.90% < 0,CSV = 41.90%,the proportion od laboratory test and inspection expense decreased,proportion of surgery anesthesia expenses showed an upward trend;(5)Since 2018,urban workers began to implement simplified DRG-based hospital payment system,the policy and system had been relatively mature,and the overall expenses structure of diseases had little change from 2018 to2019;(6)Through the interview content,it was found that there were some problems in the sample hospitals,such as immature clinical pathway,limited development of departments,asymmetric information between doctors and patients,hidden dangers,imperfect policy compensation mechanism and possible "moral hazard" of doctors.Conclusion: At present,the overall operation of simplified DRG-based hospital payment system in the sample hospitals ran well,and the proportion of drugs fees,inspection fees and laboratory test fees was declining,gradually highlighting the value of medical staff services,but the proportion of drugs in the cost composition still accounted for a large proportion,unreasonable expense setting,and the operation of medical staff was limited,while the clinical pathway was immature and the information technology management was backward.In order to promote the reform and progress of payment by disease,hospitals should improve their comprehensive strength,increase the publicity of medical knowledge and policies,health administrative departments should promote the standardized construction and management of clinical pathway,standardize the management of disease coding,pay attention to the participation of patients,accurately measure the cost of various expenses,implement the management of expenses structure,dynamically adjust the price of medical services,and set up the access permission.We should strengthen the supervision and management,strengthen the information construction of medical institutions,deepen the reform and consolidate the implementation of the medical linkage,so as to provide countermeasures and suggestions for actively carrying out the exploration of DRGs grouping by disease and smoothly adapting to the further reform of payment methods. |
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