Research On The Implementation Effects,problems And Countermeasures Of DRGs Payment Method Reform In Guangxi L City

Objective By comparing the changes of hospitalization expenses of inpatients with employee medical insurance before and after the implementation of DRGs payment reform in two tertiary A general hospitals in L City of Guangxi,four diseases including type 2 diabetes,chronic ischemic heart disease,gastritis and malignant tumors after surgery treatment is selected as cases to help to analyze the impact of the implementation of DRGs payment reform on hospitalization costs,explore the problems existing in the implementation of DRGs payment reform,and summarize experience and provide suggestions for medical institutions to better integrate into DRGs payment reform,and to provide reference for Guangxi DRGs payment reform.Methods Retrospective method is used to collect the data of inpatient expenses of employee medical insurance in sample hospitals from 2015 to 2019,and Excel 2013 was used to establish a database.The social characteristics,distribution and composition of hospitalization expenses of different inpatients in all sample data of SPSS 22.0 were analyzed by descriptive statistics,the total cost of hospitalization,drug cost,insurance fund payment,individual account payment and patient’s own expenses are quantitatively analyzed by Differences-in-Differences.And this study uses propensity score matching to test the robustness of the double difference results.Also,combined with the qualitative data obtained from the field investigation of medical security bureau and two sample hospitals in L City,and summarizing the relevant theories,research progress and domestic policy documents of DRGs payment at home and abroad,the paper evaluates the implementation effect of DRGs payment reform in L City of Guangxi.Results(1)The results of double differential regression analysis show that after the implementation of the DRGs payment reform,compared with the control hospitals,the total hospitalization costs of type 2 diabetes,chronic ischemic heart disease,gastritis and malignant tumors in the experimental group hospitals and the insurance pooling fund payment expenses all drop significantly,but the personal account payment expenses all increase significantly,of which the total hospitalization expenses respectively decrease by 14.00%,2.00%,6.00%,and42.00%,the insurance pooling fund payment expenses respectively decrease by6.00%、14.00%、16.00%、37.00%,and personal account payment fees increase by 150.00%、25.00%、46.00%、138.00% respectively.At the same time,in terms of drug costs,postoperative treatment of chronic ischemic heart disease and malignant tumors in hospitalized patients decrease respectively by 26.00% and25.00%,and hospitalized patients with type 2 diabetes and gastritis increase respectively by 12.00% and 20.00%;in terms of patient out-of-pocket expenses,inpatients with type 2 diabetes decrease by 21.00%,and hospitalized patients with chronic ischemic heart disease increase by 57.00%.There is little significant change in hospitalized patients treated for gastritis and malignant tumors after surgery.(2)This study uses the form of conference interviews and semi-structured interviews to conduct field investigations on some of the staff who actually participated in the DRGs payment reform of the Medical Security Bureau of L City,A hospital and B hospital.The survey results show that after the implementation of the DRGs payment reform,the main results are as follows:First,the personal burden rate of the general hospitalization of the employee medical insurance in L City has dropped from 24.80% to 18.70%.The employee medical insurance pool in L City has achieved a balance of income and expenditure,and 90% of the medical institutions all realizes the use of surplus.Second,the current DRGs payment reform has covered all levels of medical institutions in the city,realizing the full coverage of DRGs payment to all districts and counties,all medical institutions and employee medical insurance,resident medical insurance,critical illness medical insurance and other insurance types in the city.Third,the development concept of the hospital has changed:actively controlling medical costs;using auxiliary drugs and medical consumables rationally;increasing the number of hospitalizations for employee medical insurance;the average annual growth rate of average hospitalization costs has decreased,and the proportion of medicines has decreased.However,the DRGs payment reform still has the following problems: some hospitals suffers varying degrees of losses due to long-term hospitalization and critically ill patients;the rationality of the combination of a few disease components needs to be strengthened,especially for rehabilitation-related,malignant tumors and diseases with long hospital stays;DRGs payment standard can’t meet the cost of some new technologies and new projects.Conclusion(1)The effect of cost control reform is remarkable,which can effectively alleviate the excessive growth of medical expenses.(2)Promoting the balance of medical insurance funds and ensuring the safe use of medical insurance funds.(3)Forcing medical institutions to establish cost management concepts and optimize medical management and medical service.Combining quantitative results and qualitative analysis,problems of DRGs payment reform are as follows:(1)The payment of employee medical insurance personal accounts has increased significantly;(2)The grouping rules and points of some DRGs are unreasonable;(3)The admission and treatment of difficult and critical diseases as well as the development of new technologies and new projects are restricted;(4)It is more difficult to calculate the cost of DRGs disease;(5)The price of medical services needs to be improved.In order to promote the better development of the DRGs payment reform,the following countermeasures and suggestions are formulated:(1)Strengthen the cost management and control of medical institutions;(2)Strengthen the management of clinical pathways in medical institutions;(3)Improve the quality of the first page of medical records;(4)Actively promote Pay according to the value of curative effect;(5)Improve the pricing and adjustment mechanism of medical service prices.