根据DRG政策的实施,分析和优化骨折患者的住院费用结构
Changgeng Su1, Jiuhui Su2, Xin Li2
1College of Health Management, Changchun University of Chinese Medicine, Changchun, Jilin Province, China.
Frontiers in public health
|December 17, 2025
概括
中国的诊断相关组 (DRG) 支付改革降低了骨折患者的药物费用,但增加了诊断费用. 改革的影响因骨折类型而异,需要定制的管理策略.
科学领域:
- 卫生经济学 卫生经济学
- 创伤护理 创伤护理
- 医疗保健政策 医疗保健政策
背景情况:
- 骨折是中国的一个主要的公共卫生问题,其发病率不断上升,并造成重大经济负担.
- 全国范围的诊断相关组 (DRG) 支付改革于2019年实施,以控制医疗保健成本.
- 德格医疗改革对骨折复杂和可变的治疗成本的影响仍未得到充分研究.
研究的目的:
- 评估DRG改革对骨折患者住院费用结构的影响.
- 探索DRG改革对各种并发症和骨折类型的差异性影响.
- 为优化DRG系统下的创伤护理支付策略提供证据.
主要方法:
- 对2018-2024年期间12101名骨折患者 (ICD-10代码S22-S92) 的住院费用的结构变化分析.
- 间断时间序列 (ITS) 模型用于评估DRG改革的直接和纵向影响 (启动于2019年7月1日).
- 灰色关系分析,以确定不同成本类别对总支出的相对贡献.
主要成果:
- 德格改革显著降低了18.1%的中位数药物成本,同时增加了治疗成本和手术费用.
- 消耗品成本显示增长速度放缓,骨折类型 (例如脊柱骨折) 的显著差异.
- ITS分析显示,骨折类型对成本产生了重大影响,某些骨折 (例如S32) 的药物治疗和康复成本显著下降,诊断成本增加.
- 患有并发症的患者经历了更明显的成本调整,表明DRG在复杂病例中的成本控制效果更强.
- 灰色关系分析显示,对于不同类型的断裂,成本结构有明显的调整,其中一些具有高度集中的成本结构,而另一些则显示一般下降或稳定.
结论:
- 基于DRG的支付改革有效控制了药品支出,但导致诊断成本增加和治疗结构的转变.
- 骨折类型特定的成本调整凸显了对差异化管理策略和优化 DRG 支付标准的需求.
- 该研究提供了经验证据,支持在创伤护理中改进医疗保健支付改革.
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