Impact of DRG payment reform on the hospitalization expenses of high-ratio cases
10.3760/cma.j.cn111325-20240910-00777
- VernacularTitle:DRG付费改革对某院高倍率病例住院费用的影响
- Author:
Lulin WANG
1
;
Yi PEI
1
;
Yi HE
1
Author Information
1. 华中科技大学同济医学院附属同济医院病案科，武汉 430030
- Publication Type:Journal Article
- Keywords:
Diagnosis-related groups;
Medical insurance;
Reform of the medical insurance payment system;
High-ratio cases;
Hospitalization expense;
Interrupted time se
- From:
Chinese Journal of Hospital Administration
2025;41(8):593-598
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the impact of DRG payment reform on high-ratio cases and their hospitalization expenses, so as to provide references for deepening the reform of the medical insurance payment system.Methods:Data were collected from inpatient medical record home pages within 2019 to 2023 in a reform pilot hospital in Wuhan. All cases were grouped by the CHS-DRG grouper. The high-ratio cases were identified as hospitalization expenses exceeding 2.5 times the standard expenses. Interrupted time series model was used to analyse the impact of DRG payment reform on the proportion of high-rate cases and their hospitalization expenses. The period from January 2019 to December 2020 was the stage before the reform, and the period from January 2021 to December 2023 was the stage after the reform.Results:This study included 1 364 711 grouped cases, among which there were 159 506 high-ratio cases(78 679 cases before the reform and 80 827 cases after the reform). After the implementation of DRG payment, the proportion of high-ratio cases was decreased from 17.29% to 8.89%. The average DRG weight increased from 0.94 before the reform to 1.12 after the reform, and the average total hospitalization cost increased from 45 677.18 yuan to 52 179.32 yuan. Results from interrupted time series model showed that the proportion of high-ratio cases appear a downward trend after the reform( P=0.008). The total hospitalization cost showed an upward trend both before and after the reform( P<0.05), but the growth trend slowed down after the reform. The diagnosis cost exhibited an upward trend both before and after the reform( P<0.05), but there was a significant immediate decrease immediately after the implementation of the reform( P=0.016); The treatment cost showed an upward trend after the reform( P<0.001); The consumable cost had an upward trend before the reform( P=0.007), but the change trend after the reform was not statistically significant( P=0.544). In addition, the treatment expenses of the surgical group and the internal medical group both showed a significant upward trend after the reform( P<0.001); The consumable cost of the procedural group and the diagnosis cost of the internal medicine group both decreased immediately after the reform( P<0.05). Conclusions:DRG payment helps reduce the high-ratio cases and has a certain optimizing effec on their structure of hospitalization cost.
