| Objective:This paper analyzes the effects of medical quality and medical expenditure controlling between two Prospective Payment System based on Diagnosis Related Groups(DRGs) of County-level hospitals(secondary-level of governmental hospital) and two Fee-for-Service hospitals in three years. Analysis the questions exit in Prospective Payment System based on DRGs, and provide a reference for its improvement.Method:Several qualitative analysis methods were used to analysis the difference of these two payment systems. A total of 600 medical records from two disease types of acute appendicitis and cesarean were collected. These data were processed by Excel and SPSS statistics 16.0 software. Numeration data were described as component ratio and tested with Pearson χ2 test or Fisher s exact probability; The measurement data were described as mean and standard deviation, statistical inferences were conducted with t test or nonparametric test.Results:1 Comparing the overall running situation of NCMS in polling regionalParticipation rate and number of inpatient is no significant differences between the Prospective Payment System based on DRGs hospitals and Fee-for-Service hospitals. In Prospective Payment System based on DRGs hospitals, mean of hospitalization times and average hospitalization expenses are growing stable and has a tendency to slow down. The actual compensation ratio and use rate of catalogue drugs in the Prospective Payment System based on DRGs hospitals are higher than Fee-for-Service hospitals.2 The comparison between the time before and after of the Prospective Payment System based on DRGs hospitalsAfter the implementation of Prospective Payment System based on DRGs in Xingtai country. The mean hospitalization times were 1.00 days shorter than before(P<0.05); Average preoperative length were cut down 0.12 days(P<0.05); 98.33% of these medical records achieved “A” grade(P<0.05), and wound healing grade-A rate was attained 99.67%(P<0.05),99.33% of patients could be diagnosed in three days(P<0.05); Total cost and medicine cost decreased 303.80 yuan and 52.67 yuan respectively, the difference is statistical significance(P<0.05); About 50 antibiotic using days were abated. Results of comparison on cesarean present a similar change. the mean hospitalization times were 0.39 days shorter than before(P<0.05);“A”grade rate of medical records achieved 99.67%(P<0.05); and 99.67% in wound healing; Total cost and medicine cost decreased 379.10 yuan and 33.90 yuan respectively(P<0.05). 41.20 more antibiotic using days were abated(P<0.05).In Mancheng country, there was a similar result. The mean hospitalization times were 0.70 days shorter(P<0.05). Average preoperative length of stay were cut down 0.22 days(P<0.05). 98.00% of these medical records achieved “A” grade(P<0.05), and “A” grade rate of wound healing was 99.00%(P<0.05).98.33% of patients could be diagnosed in three days(P<0.05). Total cost, laboratory fees, examination fees and nursing fees decreased 363.34 yuan, 297.94 yuan, 135.00 yuan, 82.00 yuan and 73.50 yuan respectively(P<0.05). 19.00 antibiotic using days were abated(P<0.05). About cesarean data, the mean hospitalization times were 0.47 days shorter(P<0.05). All of medical records achieved “A” grade, and 99.5% of wound healing. Total cost and medicine cost decreased 326.90 yuan and 88.29 yuan(P<0.05); examination fees and nursing fee were also decreased than before(P<0.05); 67.80 days of antibiotic using were cut down(P<0.05).Conclusion:To varying degrees, the Prospective payment system based on DRGs has priority on reducing hospital time、control medical costs、promoting rational clinical use of drugs and improving medical services. All of these data proved that Prospective payment system based on DRGs could take a great roll in medical costs control. Combined with several governmental supervise, the Prospective payment system based on DRGs could be developed as a new payment model. |
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