Exploration of A Cost-control Model for Conducting Group-related Rational Drug Use Management under CHS-DRG Simulation Operation
10.3870/j.issn.1004-0781.2023.12.026
- VernacularTitle:国家医疗保障疾病诊断相关分组模拟运行下开展病组相关合理用药管理控费模式的探索
- Author:
Xin WANG
1
;
Jiayu LIU
;
Wanyi XU
;
Xiangli CUI
;
Junli WEI
Author Information
1. 首都医科大学附属北京友谊医院医疗保险办公室,北京 100050
- Keywords:
China healthcare security diagnosis related groups;
Simulation operation;
Rational drug use management;
Expenditure control
- From:
Herald of Medicine
2023;42(12):1890-1894
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the medical expense control model of rational drug use based on the China healthcare security diagnosis related groups(CHS-DRG)simulation in Beijing in 2021.Methods By analyzing the simulated operation data from January to March 2021 before the intervention,the groups with rational drug management improving potential among the top three surgical disease groups in terms of the number of cases enrolled in the surgical department were selected.Then,the targeted intervention and guidance were implemented to the selected disease groups.Finally,the analysis was obtained by comparing the changes in several key indicators such as the average drug cost,average antibacterial drug cost,average surplus and average length of stay during June to August 2021.Moreover,the differences in antimicrobial drug use intensity and hospital infection reporting of the department as a whole where the problematic groups were located were also investigated.Results Before the intervention,the otolaryngology related groups(including DD29 and DE19),urology surgery related groups(including LD19 and LJ13)could be improved in antibacterial drug use during the perioperative period.Meanwhile,the chest surgery related group(including EB19)had space to be improved in auxiliary medication.After the intervention,the five groups'average drug cost and average antibacterial drug cost in the otolaryngology and urology surgery departments are all decreased.The antibiotics use intensity is also declined in otolaryngology and urology surgery departments.The average surplus of otolaryngology and urology surgery related groups are increased,with the DE19 disease group in ENT also achieving a profit turnaround.As for the indicators related to the quality of care,there were no significant differences in the groups'average length of stay and nosocomial infection reporting of these departments.Conclusion The hospital operation based on CHS-DRG payment is both an opportunity and a challenge.The all-inclusive payment model has prompted hospitals to take the initiative in controlling costs,and the exploration of a rational medication management and cost-control model related to disease groups has begun to show results in terms of cost reductions without affecting the quality of medical care.The research can also provide a solid foundation for the CHS-DRG actual payment and sustainable development of medical insurance fund.
