| ObjectivesThe aim of this study is to explore the effect of DRG payment on inpatient expense control,medical service capacity and medical service quality in a tertiary hospital in Henan Province by selecting reasonable and effective effect evaluation indicators,and analyse the problems and dilemmas faced in the implementation of DRG payment,then put forward optimized countermeasures and suggestions to provide a basis for the further promotion of DRG payment.MethodsThe literature research method was used to sort out the research status,and the expert consultation method was used to determine the evaluation indicators of DRG payment.We selected the inpatient data of a tertiary hospital in Henan Province before and after the DRG payment pilot for two years(2019-2022),and used descriptive statistics analysis,structural variation analysis and interrupted time-series analysis(ITSA)which constructed a segmented linear regression model to quantitatively analyze the selected effect evaluation indicators,and we selected typical diseases for specific analysis.The semi-structured interview survey method was conducted on medical insurance institutions,medical institutions,and patients for better understanding the status and effect of DRG payment pilots.Lastly,we comprehensively analyzed the problems existing under DRG payment,and puts forward countermeasures and suggestions.Results1.In this study,11 outcome evaluation indicators were selected from inpatient expense control,medical service capacity and medical service quality.This study included 107,580 cases paid for by item and 111,599 cases paid for by DRG payment.The indicators of hospitalization expenses were significantly different before and after implementing DRG payment(P<0.05).The average hospitalization expenses dropped from 14,662.52 yuan to 12,119.41 yuan,a drop of 17.34%,and the average medical insurance compensation fee and personal out-of-pocket expenses per time were also significantly reduced.In terms of medical service capabilities: the average hospitalization days decreased significantly,from an average of11.23 days to 9.61 days,the proportion of tertiary and quaternary surgeries decreased significantly after the implementation of DRG payment,from 38.70% to 34.82%.About the medical service quality and safety:the two-week readmission rate increased from 11.01% to 12.99%,the 31 days readmission rate increased from 18.80% to 21.27% the rate of admission and discharge diagnosis coincidence after the implementation of DRG payment were significantly increased from 48.78% to 88.96%,and the incidence of adverse events decreased from 2.80% to 1.94%.2.All eight cost items decreased,in the order of-22.10% for drugs,-18.15% for consumables,-15.43% for treatment,-14.39% for laboratories and the smallest for surgery(-5.70%).Structural change analysis show that the structural change before and after the implementation of DRG payment is 4.17%.The composition ratio of drug expenses and consumables expenses decreased,and the composition ratio of examination fees,comprehensive medical expenses,and laboratory test fees increased.In descending order of contribution to structural change,pharmaceutical fees(45.08%),comprehensive medical fees(10.55%),examination fees(10.55%),laboratory fees(10.07%)and consumables fees had the lowest contribution to structural change(5.04%).The largest pulling force was in drug costs(-9.96%),followed by comprehensive medical costs(-1.49%),laboratory costs(-1.19%)and surgical costs(-1.19%).The structural change in 2021-2022(7.02%)was the largest,and the smallest in 2020-2021(2.68%),the largest variation was made in the cost of consumables and laboratory fees.3.The piecewise linear regression results of ITSA showed that the average hospitalization cost did not change significantly after the implementation of DRG payment.Personal out-of-pocket expenses maintained a monthly decline of 106.08 yuan;the average medical insurance compensation cost maintained an increasing trend;the trend of drug costs and treatment costs was not significant;the change trend of consumables cost changed from rising to decreasing;the change trend of laboratory fees changed from decreasing to increasing.The average hospital stay decreased by 2.11 days,and the overall downward trend was not significant;the instantaneous decrease in the proportion of tertiary and quaternary surgery was significant,and the overall trend of improvement was maintained.The compliance rate of admission and discharge diagnosis continued to increase before and after DRG payment;the two-week readmission rate,31-day readmission rate,and adverse event rate did not change significantly before and after DRG payment.4.The average expenses of hospitalization for stroke inpatients dropped significantly,from12,404.00 yuan to 7,286.78,yuan,a decrease of 41.25%,and the two-week readmission rate increased significantly from 1.17% to 2.87%,with the expense of treatment dropping from 1,136.88 yuan to 408.98 yuan,a decrease of 64.03%,and the cost of drugs dropping from 4,666.85 yuan to 3249.41 yuan,with a reduction of 30.37%.The average hospitalization expense for pneumonia inpatients decreased by 11.67%,but personal out-of-pocket expenses increased significantly by 15.87%.ConclusionsIn the early stage of the pilot,DRG payment has reduced inpatient medical costs,improved the efficiency of the use of health insurance funds,and reduce the burden of personal out-of-pocket costs on inpatients Continuously;the structure of inpatient costs has been adjusted slowly but gradually optimised,with a focus on consumables and laboratory fees;the capacity and efficiency of medical services have improved;DRG payment may not have a significant impact on the quality of medical services.There may be alienating medical practices such as decomposition of admissions,under-treatment,shifting the blame to seriously ill patients and choosing lighter cases;at the same time,supporting and management measures for DRG payment need to be further improved,medical service providers and medical staff lack of effective incentives and insufficient motivation for reform.In order to further promote DRG payment,medical insurance institutions should unify and optimise their information service platforms and improve the cost control mechanism;improve the medical insurance supervision system by scientific and intelligent supervision;and smooth the communication and consultation mechanism between medical insurance institutions and medical service providers through multiple channels.Medical service providers should actively promote the application of DRG performance management tools;optimise clinical pathways and strengthen internal hospital management. |
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