The Methodology Study Of Formulating Criteria Of Inpatient's Charges In Terms Of DRGs In Yunnan Provincial Comprehensive Hospitals

Objective:The methodology study of formulating criteria of inpatients charges in terms of (Diagnosis related groups)DRGs in Yunnan provincial comprehensive hospitals, aims to advance the application of case mix systems in Yunnan hospitals management, provide a scientific information to conduct hospital to formulate reasonable systems of medical expenditure, control the increase of medical expenditure effectively, implement payment systems of DRGs step by step.Method: Based on literature review, this study introduces two methods to formulate criteria of polyclinic Inpatient's charges in terms of DRGs, one method is to compute the average charge of each DRGs based on materials characteristics and distribution, moreover by using adjusted index of hospital scale and methods of computing compound interest, to forecast the average charges of each DRGs belonging to second-class hospitals in different time; the other method is a relative method computing criteria of inpatient's charges per DRGs, the first step, we need set up a DRGs as reference benchmark, afterward compute a set of DRG relative weights in term of reference DRGs, we can get the whole criteria of comprehensive hospitals Inpatienf s charges according to DRGs relative weights as long as obtaining average charges of reference DRGs in different time and place.Results: Set up a whole criteria and upper limit of inpatient's charges for large-scale comprehensive hospital by directly computing median(M) and geometric mean(G)of inpatient's charges in each DRG, our results also show estimating value of average inpatient's charges of each DRG belonging to second-class hospitals in different time. In addition we confinn average cost of DRG240 as reference benchmark, get a set of DRG relative weights by two methods and obtain criteria of inpatient's charges of each DRG insecond-class hospitals in 2002 year, moreover summarized computing methods and concrete applications of the criteria.Conclusion: The opening and dynamic criteria scheme of inpatient's charges have good representative and practicality because of large size of samples and generally considering other factors of inpatient's charges at the time of case mix classification, the establishment of scheme could provide a scientific basis for Medicare institution to make rules on reimbursement of inpatient's charges.