Analysis Of The Effect Of Grouped Disease-based Payment

Objective:To explore the effect of Grouped Disease-based Payment by comparing and analyzing the date of stroke cases in two counties with different medical insurance payment methods.Summarize experience and problems found in the implementation of Grouped Disease-based Payment,so as to provide a theoretical basis for the further implementation of the payment.Methods:Collect medical insurance data of stroke cases in Xi County and Guangshan County from 2015 to 2017 for comparative analysis.Descriptive statistics and chi-square test were used to analyze the two groups of research subjects.Use the structural change degree to analyze the trend of hospitalization expenses and the change of expense structure of stroke patients between 2015 and 2017 in two counties.DID model was used to analyze the index data of cost items of 2015 and 2017 in two counties,and to explore the effect of the implementation of Grouped Disease-based Payment.Quantitative data that follow the normal distribution were described as mean± standard deviation,and TwosampleT-test was performed.Quantitative data that do not follow the normal distribution were described as M(P25?P75),and nonparametric rank-sum test was performed.Qualitative data performed Chi-square test.The test levels were all ?=0.05.Results:1.The number of stroke cases in Xi County was 11,175(56.29%),and that in Guangshan County was 8,676(43.71%).There was no difference in age distribution and gender distribution between two counties.2.From 2015 to 2017,the overall hospitalization cost of Xi County decreased significantly.The average total hospitalization expenses decreased from 5115.42 yuan to 4750.45 yuan,a decrease of 8.10%.There were 5 items decreased and 3 items increased,and drug costs decreased by 23.61%.The inspection costs decreased by 20%,the surgical costs increased by 25.72%,treatment costs increased by 23.85%,and laboratory test costs increased by 14.05%.From 2015 to 2017,the overall hospitalization expenses of Guangshan County increased significantly.The average total hospitalization expenses increased from 5254.46 yuan to 5808.85 yuan,an increase of 11.35%,of which 8 items have all increased,drug costs increased by 9.00%,inspection costs increased by 13.83%,surgical costs increased by 14.40%,treatment costs increased by 15.54%,and laboratory test costs increased by 14.35%.3.From 2015 to 2017,the degree of change in overall cost structure of Xi County was 19.84%and Guangshan County was 2.41%,the change in cost structure of Xi County was obvious,but Guangshan County was not.From 2015 to 2017,the contribution rate index of the structural change of hospitalization expenses in Xi County was from high to low in order of drug costs(33.82%),surgery costs(18.25%),treatment costs(13.66%),inspection costs(11.04%),laboratory test costs(9.88%).From 2015 to 2017,the contribution rate index of structural change of hospitalization expenses in Guangshan County was from high to low in order of drug costs(36.51%),inspection costs(14.94%),treatment costs(12.45%),and operation costs(10.79%).From 2015 to 2017,drug costs,inspection costs,surgical costs,treatment costs and laboratory test costs were the main driving force indicators of the change in the cost structure of two counties.4.In 2015 and 2017,,the score of DID between the average total hospitalization expenses of Xi County and Guangshan County was-29.46%.The score of DID in the proportion of drug costs between Xi County and Guangshan County was-14.75%,the score of DID between the proportion of inspection costs was-15.17%,the score of DID between the proportion of bed costs,the proportion of nursing costs,and the proportion of material costs were all negative,the score of DID between the proportion of surgical costs was 34.07%,the score of DID between the proportion of treatment costs was 31.01%,and the score of DID between the proportion of laboratory test costs was 21.41%.The range of hospitalization days in Xi County was '-1' day and Guangshan County was 1 day,the score of DID between the two counties was 2 days.Conclusion:The Grouped Disease-based Payment can reduce the hospitalization expenses of stroke patients,and also has a positive effect on optimizing the cost structure,which can reduce the proportion of drug costs,inspection costs,bed costs,nursing costs and material sosts,and can increase the proportion of surgical costs,treatment costs,and laboratory test costs which reflect the value of technical labor services to a certain degree,and can also shorten the patient's hospital stay to a certain degree.