Research On The Effect Of DRGs Payment System On The Control Of Medical Expenses

It is one of the main objectives of China’s medical and health system reform to strictly control the excessive increase of hospitalization costs and to solve the problem of "difficult and expensive medical treatment" for the people.With the development of economy and society,our social security development has shown that the policy coverage is expanding,the number of insurance participants is increasing year by year,and the medical expenditure is increasing.It is an inevitable trend to accelerate the reform of medical insurance payment method.At present,more and more countries implement the new medical insurance payment method of Diagnosis Related Groups(DRG),which plays an important role in ensuring the smooth operation of medical insurance fund,reducing the medical burden of the people,and realizing the rational allocation of medical resources.From the perspective of current medical practice,the implementation of DRGs payment system has played a certain role in reducing the pressure of medical insurance fund and controlling the unreasonable growth of hospital costs,but it has also brought a series of problems.The research focus of this paper is to analyze the influence of DRGs payment system on hospital expenses and explore a series of problems in the process of controlling the unreasonable increase of hospital expenses.On the basis of systematic sorting out the current situation of Chinese medical expenditure and the progress of DRGs system reform,firstly,the generalized linear regression model was used to analyze the changes of the total hospital cost,the total out-of-pocket cost,the total insurance compensation cost,the proportion of the total out-of-pocket cost and the average number of hospital days before and after the implementation of DRGs system.Secondly,the changes of hospitalization days and various cost indexes before and after the implementation of the DRGs system for different types of medical insurance and different types of medical insurance were analyzed,in order to explain the differences in cost control effects of the DRGs payment system between different types of medical insurance and different types of medical insurance.Thirdly,in order to explore the influence of DRGs system on the structural change of hospitalization costs,the structural change degree analysis method was used to explore the changes of DSV,VSV and contribution rate of structural change of operation costs,diagnostic costs,consumables costs,pharmaceutical costs and other cost items after the implementation of DRGs system.Finally,according to empirical results and our country’s DRGs system practice analyzed a series of problems that DRGs system faces in the process of controlling the unreasonable increase in hospital costs,and put forward countermeasures and suggestions.The empirical results show that: 1.DRGs system has a significant effect on controlling the unreasonable increase of hospitalization days,but has no significant effect on the total hospitalization costs and out-of-pocket costs.2.The cost control effect of DRGs payment system is different among different types of medical insurance.Compared with urban and rural residents’ basic medical insurance patients,the DRGs system has a better control effect on the hospitalization costs of urban employees’ basic medical insurance patients.3.The cost control effect of DRGs payment system is different among different diseases.On the one hand,the DRGs system has a better control effect on the out-of-pocket costs of diabetic patients,but a poor control effect on the out-of-pocket costs of hospitalized delivery and appendicitis patients.On the other hand,compared with mild patients,the DRGs system has no obvious effect on the hospitalization cost control of critically ill patients.4.After the implementation of the DRGs system,the structure of hospitalization cost changes are unreasonable,and the cost of drugs and consumables is still the two main costs that increase the medical burden of patients.According to the empirical results and the in-depth analysis of our DRGs system reform practice,we found that there were some problems in the implementation process of our DRGs system,such as diagnosis upgrading,cost transferring,quality of service decreasing,insufficient compensation for severe patients,and low coverage.In order to improve the implementation effect of DRGs system,this paper deeply analyzes the root causes of each problem based on the current practice,and on the basis of learning from international experience,Specific improvement strategies are proposed from the aspects of improving the supervision of the implementation process of the DRGs payment system,taking into account the fairness and efficiency of the implementation of the DRGs system,improving the cost compensation mechanism of the DRGs system,and developing the performance appraisal and evaluation system based on the DRGs payment system.The purpose is to improve the operation efficiency of the DRGs system and achieve a win-win situation among the three parties,namely,the medical,insurance and patient.