Study on an age-adjusted cost model of the prospective payment system under diagnosis-related groups
10.3760/cma.j.issn.0254-9026.2023.11.015
- VernacularTitle:疾病诊断相关分组预定额付费制下患者年龄因素费用调整模型研究
- Author:
Chao LI
1
;
Suowei WU
;
Ji LUO
;
Yuanyuan GAI
Author Information
1. 北京医院医务处 国家老年医学中心 中国医学科学院老年医学研究院，北京 100730
- Keywords:
Age;
DRG-PPS;
Hospitalization cost;
Cost adjustment
- From:
Chinese Journal of Geriatrics
2023;42(11):1357-1362
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the adjustment of the amount of medical insurance reimbursement with the addition of the age factor, making the system more in line with the actual clinical resource consumption.Methods:Data were collected from the first page of medical records of 54 535 inpatients discharged from hospital between January 1 th, 2021 and December 31 th, 2021.First, the paired t-test was used to verify any statistical difference between the standard payment amounts before and after adjustment based on the model and the actual hospitalization expenses.Secondly, the actual cost was compared with the cost after the model-based adjustment and the current benchmark cost(before adjustment), respectively.The standard deviations of the two groups were compared to assess the difference between the benchmark cost and the actual cost before and after adjustment. Results:Through the Blom formula, the actual cost, adjusted benchmark cost and current benchmark cost data were normalized.After normalization, the actual expenses and the adjusted benchmark cost as well as the actual expenses and the current benchmark cost were compared, respectively, using the paired t-test, producing a P value of 0.97 for the former pair and a P value of 0.93 for the latter pair, both greater than 0.05, and the benchmark cost before and after adjustment could reflect the actual clinical resource consumption.However, the effect of benchmark cost adjustment was assessed by analyzing the standard deviation of the difference between paired values of the two groups.The standard deviation of paired values between the actual expense and the adjusted benchmark cost was 0.68, lower than the standard deviation of paired values between the actual expense and current benchmark cost, which was 0.7. Conclusions:With the inclusion of the age factor, the model can reasonably adjust the current benchmark cost based on the patient's age and verify that the adjusted benchmark cost can more accurately reflect the actual clinical resource consumption compared with the current standard.However, further improvement of the payment adjustment model is still needed.
