The Study On Hospital Expenses Of Patients With Cholecystitis Related To DRGs In Anhui Province

Objective: In order to examine the performance of payment related to the diagnosis related groups(DRGs) in Anhui province, by analyzing the differences of medical quality to cure the gallstone complicated with acute cholecystitis before and after the DRGs, and the changes of the hospital expenses and composition ratio, we have explored the key factors which influence the hospital expenses of patients who get gallstone complicated with acute cholecystitis, and find the unreasonable part of the hospital expenses that leads to provide feasible ideas and suggestions for further deepening the payment reform.Methods: During the time span of January 2011 to June 2014, we randomly selected to study the patients who get gallstone complicated with acute cholecystitis in the county hospitals within the sample areas, in which cases from January 2011 to September 2012 performed traditional medical services by the traditional fee-payment, and the cases from October 2012 to June 2014 performed the medical services in accordance with the implementation of clinical pathways by DRGs. We obtained the research data by using the method of combining on-site inspection of the original medical records with information platform which exports the list of charges. On the basis of comparing the changes of the quality of medical care and hospital expenses between two groups of patients, we utilize the method of multiple linear regression and Logistic regression to construct the regression equation of hospital expenses of two groups of patients respectively.Results: 1For the group paid by service, the average cost of hospitalization was 6026.0 ± 2151.52 yuan, however, for another group paid by DRGs, was 5550.8 ± 1714.7 yuan, the difference of these two groups have statistical meaning. According 2to the composition of cost of hospitalization of these two groups, the expenses of the top three are medicine fee, operation fee and materials fee; Between these two groups, the differences of expenses for medicine, nursing, daily room, operation, examination, tests, anesthesia and others have statistically significant, however, for materials and treatment do not. 3Consider the results of univariate analysis, multiple linear regression and Logistic regression, we obtained that the five variables involve drugs rate, hospitalization, anesthesia, regional economic level and admission illness are the key factors to affect the level of the hospital expenses of patients who get gallstone complicated with acute cholecystitis.Conclusions: The payment reform effectively reduce the hospital expenses of patients who get gallstone complicated with acute cholecystitis. In order to further achieve thepurpose of cost control, administrative departments for public health, health care departments and hospital management department should work together to strengthen the control over the use of drugs and medical consumables; shorten hospitalization time of patients; strengthen the management of clinical pathway, improve the performance appraisal system; improve the cost consciousness of the medical institution itself by raising the management level; promote the implementation of the external evaluation mechanism for medical service quality.